Endoscopy 2022; 54(08): 797-826
DOI: 10.1055/a-1859-3726
Position Statement

Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

 1   Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
,
Mario Dinis-Ribeiro*
 2   Porto Comprehensive Cancer Center (Porto.CCC), and RISE@CI-IPOP (Health Research Network), Porto, Portugal
,
Heiko Pohl
 3   Dartmouth Geisel School of Medicine, Hanover, New Hampshire, and Section of Gastroenterology and Hepatology, VA White River Junction, Vermont, USA
,
Deepak Agrawal
 4   Division of Gastroenterology and Hepatology, Dell Medical School, University of Texas Austin, Texas, USA
,
Marianna Arvanitakis
 5   Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Robin Baddeley
 6   King’s Health Partners Institute for Therapeutic Endoscopy, King’s College Hospital, and Wolfson Unit for Endoscopy, St Mark’s Hospital, London, United Kingdom
,
Elzbieta Bak
 7   Department of Gastroenterology and Internal Medicine, Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
,
Pradeep Bhandari
 8   Gastroenterology, Portsmouth Hospital NHS Trust, Portsmouth, UK
,
Michael Bretthauer
 9   Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Patricia Burga
10   Endoscopy Department, University Hospital of Padua, Italy
,
Leigh Donnelly
11   Endoscopy Department, Northumbria Healthcare NHS Trust, Northumberland, United Kingdom
,
Axel Eickhoff
12   Klinik für Gastroenterologie, Diabetologie, Infektiologie, Klinikum Hanau, Hanau, Germany
,
13   Department of Gastroenterology, University College London Hospitals, London, United Kingdom
,
Michal F. Kaminski
14   Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
,
Katarina Karlović
15   Clinical Hospital Center Rijeka , Department of Gastroenterology, Endoscopy Unit, Rijeka, Croatia
,
16   Department of Gastroenterology, University and Polytechnic La Fe Hospital/IIS La Fe, Valencia, Spain
,
17   Department of Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
,
Mathieu Pioche
18   Endoscopy Unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
,
19   Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
,
Peter D. Siersema
20   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
William Stableforth
19   Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
,
21   Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
,
22   Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
,
23   Digestive Endoscopy Unit, ULSS 2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy
,
Andrew Veitch
24   Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
,
25   Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
,
George J. Webster
13   Department of Gastroenterology, University College London Hospitals, London, United Kingdom
,
Ariane Vienne
26   Hôpital Privé d’Antony, Antony, France
,
Ulrike Beilenhoff
27   Ulm, Germany
,
28   Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
,
Cesare Hassan
29   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Ian M. Gralnek
30   Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
,
Helmut Messmann
31   III Medizinische Klinik Universitätsklinikum Augsburg, Augsburg, Germany
› Author Affiliations

Abstract

Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. Main statements 1 GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2 ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3 ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4 ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5 ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6 ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7 ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8 ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9 ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10 ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.

* Joint first authors


Supplementary material



Publication History

Article published online:
08 July 2022

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