The environmental impact of small-bowel capsule endoscopy

Mathieu Pioche; Joao A. Cunha Neves; Heiko Pohl; Minh-Quyen Lê; Raphaelle Grau; Xavier Dray; Clara Yzet; Mikael Mochet; Jérémie Jacques; Timothée Wallenhorst; Jérôme Rivory; Nadège Siret; Anne-Laure Peillet; Jean-Baptiste Chevaux; François Mion; Ulriikka Chaput; Philippe Jacob; Daniel Grinberg; Jean-Christophe Saurin; Robin Baddeley; Enrique Rodriguez de Santiago; Pierre-Jean Cottinet; and the Sustainability Committee of the French Endoscopy Society (SFED)

doi:10.1055/a-2313-5142

Endoscopy, Table of Contents

Endoscopy 2024; 56(10): 737-746
DOI: 10.1055/a-2313-5142

Original article

The environmental impact of small-bowel capsule endoscopy

Mathieu Pioche

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Joao A. Cunha Neves

²Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal

,

Heiko Pohl

³Departments of Gastroenterology, VA Medical Center, White River Junction, Vermont; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

,

Minh-Quyen Lê

⁴Material Analysis Laboratory, INSA Lyon, Villeurbanne, France

,

Raphaelle Grau

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Xavier Dray

⁵Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France

,

Clara Yzet

⁶Endoscopy and Gastroenterology Unit, University Hospital, Amiens, France

,

Mikael Mochet

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Jérémie Jacques

⁷Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France

,

Timothée Wallenhorst

⁸Gastroenterology and Endoscopy Unit, University Hospital Pontchaillou, Rennes, France

,

Jérôme Rivory

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Nadège Siret

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Anne-Laure Peillet

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Jean-Baptiste Chevaux

⁹Gastroenterology and Endoscopy Unit, University Hospital Brabois, Nancy, France

,

François Mion

¹⁰Digestive Physiology Department, Hospices Civils de Lyon, Lyon, France

,

Ulriikka Chaput

⁵Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France

,

Philippe Jacob

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

¹¹Gastroenterology and Endoscopy Unit, Nimes Private Clinic, Nimes, France

,

Daniel Grinberg

⁴Material Analysis Laboratory, INSA Lyon, Villeurbanne, France

¹²Cardiac Surgery, Cardiologic Hospital, Hospices Civils de Lyon, Lyon, France

,

Jean-Christophe Saurin

¹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Robin Baddeley

¹³Wolfson 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

¹⁴Department 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

⁴Material Analysis Laboratory, INSA Lyon, Villeurbanne, France

,

and the Sustainability Committee of the French Endoscopy Society (SFED)

› Author Affiliations

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.

Full Text

References

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