Download PDF
Endoscopy
DOI: 10.1055/a-2313-5142
Original article

The environmental impact of small-bowel capsule endoscopy

Mathieu Pioche
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Joao A. Cunha Neves 
 2   Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
,
Heiko Pohl
 3   Departments of Gastroenterology, VA Medical Center, White River Junction, Vermont; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
,
Minh-Quyen Lê
 4   Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
,
Raphaelle Grau
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Xavier Dray
 5   Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
,
Clara Yzet
 6   Endoscopy and Gastroenterology Unit, University Hospital, Amiens, France
,
Mikael Mochet
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jérémie Jacques
 7   Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Timothée Wallenhorst
 8   Gastroenterology and Endoscopy Unit, University Hospital Pontchaillou, Rennes, France
,
Jérôme Rivory
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Nadège Siret
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Anne-Laure Peillet
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jean-Baptiste Chevaux
 9   Gastroenterology and Endoscopy Unit, University Hospital Brabois, Nancy, France
,
François Mion
10   Digestive Physiology Department, Hospices Civils de Lyon, Lyon, France
,
Ulriikka Chaput
 5   Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
,
Philippe Jacob
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
11   Gastroenterology and Endoscopy Unit, Nimes Private Clinic, Nimes, France
,
Daniel Grinberg
 4   Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
12   Cardiac Surgery, Cardiologic Hospital, Hospices Civils de Lyon, Lyon, France
,
Jean-Christophe Saurin
 1   Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Robin Baddeley
13   Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute; King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital; and Imperial College London, London, UK
,
Enrique Rodriguez de Santiago 
14   Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
,
Pierre-Jean Cottinet
 4   Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
,
and the Sustainability Committee of the French Endoscopy Society (SFED) › Author Affiliations
› Further Information
Also available at
   Permissions and Reprints


Abstract

Introduction The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure.

Methods Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts.

Results The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43–119 g) accounted for 9 %–97 % of total weight, and included deactivation magnets (5 g [4 %–6 %]) and paper instructions (11–50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2, with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible.

Conclusion The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions.



Publication History

Received: 14 November 2023

Accepted after revision: 24 April 2024

Accepted Manuscript online:
24 April 2024

Article published online:
18 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Pioche M, Lambin T, Rivory J. Let’s urgently engage ourselves in “greening” endoscopy to address ecological issues!. Endosc Int Open 2021; 9: E1752-E1753
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Leddin D, Omary MB, Veitch A. et al. Uniting the global gastroenterology community to meet the challenge of climate change and non-recyclable waste. Gastroenterology 2021; 161: 1354-1360
    CrossrefPubMedGoogle Scholar
  • 3 Siau K, Hayee B, Gayam S. Endoscopy’s current carbon footprint. Tech Innov Gastrointest Endosc 2021; 23: 344-352
    CrossrefPubMedGoogle Scholar
  • 4 Maurice JB, Siau K, Sebastian S. et al. Green endoscopy: a call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol 2020; 5: 636-638
    CrossrefPubMedGoogle Scholar
  • 5 Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. Waste Manag Res 2018; 36: 39-47
    CrossrefPubMedGoogle Scholar
  • 6 Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H. et al. 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. Endoscopy 2022; 54: 797-826
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Lacroute J, Marcantoni J, Petitot S. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 55: 918-926
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Yzet C, Figueiredo M, Michoud C. et al. Ecological impact of endoscopic dilatation using the bougie cap device: a low-tech innovation to reduce waste by 99. Endoscopy 2022; 54: E824-E825
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022; 71: 1326-1331
    CrossrefPubMedGoogle Scholar
  • 10 Dray X, Buzzi J, Quentin V. et al. Small bowel capsule endoscopy and deep enteroscopy procedure load in France: a nationwide population-based study over 7 years. Endosc Int Open 2023; 11: E1013-E1019
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Ashby M. Materials and the Environment: Eco-informed Material Choice. 2nd edn. Oxford: Elsevier; 2012
    Google Scholar
  • 12 Ashby M. The energy-fingerprints of products. Cambridge: Granta Design Ltd; 2012
    Google Scholar
  • 13 Ashby M, Miller A, Rutter F. et al. CES EduPack for Eco Design – A White Paper. Cambridge: Granta Design Ltd; 2012
    Google Scholar
  • 14 Sharma A, Minh Duc NT, Luu Lam Thang T. et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med 2021; 36: 3179-3187
    CrossrefPubMedGoogle Scholar
  • 15 Ditac G, Cottinet P-J, Quyen LeM. et al. Carbon footprint of atrial fibrillation catheter ablation. EP Europace 2023; 25: 331-340
    CrossrefPubMedGoogle Scholar
  • 16 Grinberg D, Buzzi R, Pozzi M. et al. Eco-audit of conventional heart surgery procedures. Eur J Cardiothorac Surg 2021; 60: 1325-1331
    CrossrefPubMedGoogle Scholar
  • 17 Materials Database Highlighted Workshop. ASM International Medical Materials Database highlighted at FDA Biodegradable Metals Workshop. 2012 Available from (Accessed 9 May 2024): https://www.todaysmedicaldevelopments.com/news/asm-materials-database-031612/
    PubMedGoogle Scholar
  • 18 Accueil | Impact CO2 . Available from (Accessed 9 May 2024): https://impactco2.fr
    PubMedGoogle Scholar
  • 19 Charret G, Arnaud A, Berthoud F. et al. Estimation de l’empreinte carbone du stockage de données. French National Center for Scientific Research [CNRS] –GRICAD. 2020 Available from (Accessed 9 May 2024): https://cnrs.hal.science/hal-03573790
    PubMedGoogle Scholar
  • 20 Jin H, Afiuny P, McIntyre T. et al. Comparative life cycle assessment of NDFEB magnets: virgin production versus magnet-to-magnet recycling. Procedia CIRP 2016; 48: 45-50
    CrossrefPubMedGoogle Scholar
  • 21 Hillman K, Damgaard A, Eriksson O. et al. Climate benefits of material recycling : inventory of average greenhouse gas emissions for Denmark, Norway and Sweden. Copenhagen: Nordisk Ministerråd; 2015
    CrossrefGoogle Scholar
  • 22 Deubzer O. Reduction of hazardous materials in electrical and electronic equipment. Goodship V, Stevels A, Huisman J. Waste Electrical and Electronic Equipment (WEEE) Handbook. 2nd edn. Woodhead Publishing; 2019: 207-230
    Google Scholar
  • 23 Parisi I, Badat S, El-Husseiny MH. et al. P149 Evaluation of the at-home capsule endoscopy (ACE) service at UCLH: preliminary findings. Gut 2022; 71: A113-A113
    PubMedGoogle Scholar
  • 24 EUR-Lex: EU Law and Publications. Disposal of spent batteries. Available from (Accessed 9 May 2024): https://eur-lex.europa.eu/FR/legal-content/summary/disposal-of-spent-batteries.html
    PubMedGoogle Scholar
  • 25 Enns C, Galorport C, Ou G. et al. Assessment of capsule endoscopy utilizing Capsocam Plus in patients with suspected small bowel disease including pilot study with remote access patients during pandemic. J Can Assoc Gastroenterol 2021; 4: 269-273
    CrossrefPubMedGoogle Scholar
  • 26 Zwinger LL, Siegmund B, Stroux A. et al. CapsoCam SV-1 versus PillCam SB 3 in the detection of obscure gastrointestinal bleeding: results of a prospective randomized comparative multicenter study. J Clin Gastroenterol 2019; 53: e101-e106
    CrossrefPubMedGoogle Scholar
  • 27 Pioche M, Vanbervliet G, Jacob P. et al. Prospective randomized comparison between axial- and lateral-viewing capsule endoscopy systems in patients with obscure digestive bleeding. Endoscopy 2014; 46: 479-484
    PubMedGoogle Scholar