Ecological impact of endoscopic dilatation using the bougie cap device: a low-tech innovation to reduce waste by 99 %

Endoscopic dilatation for esophageal stenosis is an invasive and repetitive procedure. Different modalities exist (balloon dilatation, bougie dilatation) with similar efficacy [1], but their different ecological impact should be considered during endoscopic procedures [2] [3]. We report the technique of dilatation using the bougie cap (Ovesco, Tuebingen) that could have an impact on reducing waste during this kind of procedure.

A 20-year-old woman with a caustic esophageal stenosis was referred to our center for a first dilatation. The stenosis was located in the middle esophagus, measured 2 cm, and was not passable by the endoscope. From the available methods, we chose to use the bougie cap given its lowest weight of waste (3 grams in total with package) compared with the balloon dilatation strategy using a balloon and manometer (483 grams, [Fig. 1]). After inserting the cap on the extremity of the endoscope, the latter was pushed through the stenosis provoking mucosal linear damage and a widening of the lumen ([Video 1]). No immediate complication was noticed.

Fig. 1 Strategies of dilatation with the available devices and weight of waste. a Bougie cap device. b Weight of the bougie cap with its package. c Balloon dilation kit with balloon and manometer and its weight. d Conventional bougies.

Video 1 Ecological impact of endoscopic dilatation using the bougie cap device: a low-tech innovation to reduce waste by 99 %.

From an ecological perspective, the use of this technique could significantly reduce our plastic waste (99 % less). Bougie dilatation is an alternative because it is re-usable, however disinfection can be suboptimal raising hygiene issues [4]. Studies are urgently needed to confirm the medico-economical and environmental advantages while preserving the efficacy and safety profile of dilatation strategies.

Endoscopy_UCTN_Code_TTT_1AO_2AH

• References

• 1 Josino IR, Madruga-Neto AC, Ribeiro IB. et al. Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2018; 2018: 1-9
• 2 Pioche M, Lambin T, Rivory J. Let’s urgently engage ourselves in “greening” endoscopy to address ecological issues!. Endosc Int Open 2021; 09: E1752-E1753
• 3 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2021;
• 4 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50: 1205-1234