Comparative carbon footprint and environmental impact of biodegradable pancreatic stent versus conventional plastic stent usage in ERCP

Aims Plastic pancreatic stents are widely used for the prevention of post-ERCP pancreatitis (PEP). However, these patients require further care post-procedure to confirm spontaneous stent passage and repeat endoscopy for stent removal if migration has not occurred (in approximately 20%). The development of a 6F biodegradable (BD) stent (Archimedes, Q3 Medical, Dublin, Ireland), which can be used for the same indications, removes the need for additional post-procedure care. This study aimed to evaluate the additional carbon footprint related to the environmental impact of the care pathway using plastic (non-BD) pancreatic stents compared with using BD stents.

Methods A retrospective analysis was performed of all patients across 2 tertiary centres who had either plastic or BD prophylactic pancreatic stents inserted over 3 years. Their episodes of care for follow up x-rays and endoscopy were retrieved from medical records. Conservative estimates of potential carbon dioxide equivalent (CO2e) of travel, imaging and endoscopy were extrapolated from recent scientific literature. Distances travelled for episodes of care were calculated. The carbon cost of car travel was 0.138kg/km travelled, as published by Department of Transport. The CO2e for x-rays was 0.5kg (McAlister, 2023). The CO2e was calculated as 10.4kg per procedure (Henninger, 2023). The carbon footprint of the index procedure was assumed to be the same and the impact of the choice of the stent itself excluded from calculations.

Results 174 patients received pancreatic stents for PEP. 12 patients who had planned repeat ERCPs for clinical reasons were excluded. Thus, 162 patients were included in the study (79 female (49%), mean age 52 years [range 3 – 96]. 94 patients received BD stents. No BD stent patients required follow up imaging or endoscopy. Of the plastic stent patients, 62 had one repeat x-ray, whilst a further 6 had a second x-ray to assess for stent migration and 15 required repeat endoscopy to retrieve the stents. As a result, the rate of retained plastic pancreatic stents was 22.1%.The mean CO2e for travel for post-plastic stent care per patient was 15.24kg per patient, based on car travel, accounting for 84.3% of the mean excess footprint of plastic stent care, which was 18.08kg CO2e. The total CO2e for plastic stent follow-up care was 1.229 tonnes. For BD stent patients there was no additional CO2e impact beyond the index procedure. The environmental impact of the 77.9% of non-biodegradable stents which pass spontaneously (and therefore into the sewage system) was not costed. [1] [2] [3]

Conclusions In this study, plastic stent care for 68 patients incurred an additional 1.229 tonnes CO2e. This is the equivalent of 8935.9km (5,552.5 miles) driven in an average car. BD pancreatic stents placed for PEP eliminate the need for post-procedure follow-up care and in turn reduce carbon footprint and non-recyclable waste generation. Uptake of new technologies such as BD stents may therefore have a meaningful role in delivering more environmentally sustainable healthcare.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Department for Transport, Transport and Environment Statistics 2022 – GOV.UK, Accessed November 20, 2023
• 2 Henniger D, Windsheimer M. et al. Assessment of the yearly carbon emission of a gastrointestinal endoscopy unit. Gut 2023; 72: 1816-1818
• 3 McAlister S, McGain F. et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac 2022; 3 (24) 100459

Publication History

Article published online:
15 April 2024