Endoscopy's Current Carbon Footprint

ABSTRACT Each year, over 18 million endoscopy procedures are performed in the United States (US) alone. Endoscopy is the third highest generator of waste in healthcare, a sector with significant contributions to carbon emissions worldwide. Endoscopy carries a substantial carbon footprint owing to its resource-heavy decontamination processes, complex waste streams, high throughput caseloads and its heavy reliance on single-use, non-recyclable consumables. In this review, we aim to identify sources of waste within endoscopy, provide a framework approach for measuring the carbon footprint, and propose actionable steps that can be delivered to mitigate endoscopy's carbon footprint. Based on operational energy usage and plastic waste from endoscopic procedures alone, we estimate the carbon footprint of endoscopy in the US at 85,768 metric tonnes of CO2 emissions annually, equivalent to more than 9 million gallons of gasoline consumed, 94 million pounds of coal burned and 212 million miles driven in average non-electric car. Sequestering these CO2 emissions would require an additional 112,000 acres of new forests per year. Urgent action is therefore needed within endoscopy units. Units should start by embracing the 3R's of sustainability - “Reduce, Re-use, Recycle”. Patient and administrative pathways in endoscopy should be process mapped to identify opportunities for sustainability interventions at each step. Finally, we propose a taxonomy of sustainability interventions where a pragmatic “Review, Research and Reinvent” approach can be applied at all levels, ranging from the individual to international societies, to minimise the carbon footprint of endoscopy.