Unveiling the hidden impact: Scope 3 emissions in endoscopy

The study by López-Muñoz et al. published in this issue of Endoscopy provides a critical analysis of the carbon footprint associated with single-use duodenoscopes (SUDs) and reusable duodenoscopes (RUDs), offering valuable insights into the broader environmental impact of medical equipment [1]. By modeling three distinct clinical scenarios, the authors highlight the substantial difference in carbon emissions between the approaches, emphasizing particularly the environmental benefits of reusable devices; however, the study also brings to light an often underestimated aspect of environmental impact in healthcare: Scope 3 emissions.

Scope 3 emissions refer to the indirect emissions that occur throughout a product's value chain, including those generated during the production, transportation, and disposal of medical equipment. Unlike Scope 1 and 2 emissions, which are directly tied to healthcare facilities and their energy consumption, Scope 3 emissions encompass the full lifecycle of the equipment used, making them more challenging to measure, and meaning they often overlooked in environmental assessments. While Scope 1 and 2 emissions are relatively straightforward to measure and report, Scope 3 emissions are more complex, leading companies often to rely on industry averages in their estimates.

“These findings starkly highlight the environmental advantages of reusables, not only in reducing waste, but also in minimizing the Scope 3 emissions associated with their lifecycle.”

A key strength of the study by López-Muñoz et al. is their meticulous approach in determining the composition of the duodenoscopes in a material science laboratory. This enables a more accurate estimation of the carbon emissions linked to the manufacture of these instruments, addressing a crucial component of Scope 3 emissions. By identifying the specific materials used in SUDs and RUDs, the authors can better approximate the carbon footprint associated with their production – a factor that is frequently neglected in studies focused solely on the operational phase of medical devices.

Furthermore, the study’s inclusion of end-of-life incineration emissions for SUDs is particularly noteworthy. The data, sourced from third-party providers, highlights the significant environmental burden posed by the disposal of single-use devices. Incineration, a common method for disposing of medical waste, releases a considerable amount of carbon dioxide and other harmful pollutants, substantially contributing to the overall carbon footprint of SUDs. This finding is crucial, as it illustrates the disproportionate impact of the end-of-life phase on the total emissions of single-use devices – a component of Scope 3 emissions that is rarely accounted for in environmental impact studies.

The results of this study are compelling: the carbon footprint of RUDs is 62–82 times lower than that of single-use devices in a scenario of universal SUD use and 10 times lower in a scenario where SUDs are used only occasionally. These findings starkly highlight the environmental advantages of reusables, not only in reducing waste, but also in minimizing the Scope 3 emissions associated with their lifecycle.

Yet, the significance of these findings extends beyond the specific context of duodenoscopes. They prompt a broader reflection on the healthcare industry’s approach to environmental sustainability. The overwhelming focus on direct emissions and operational efficiency has led to an underestimation of the true environmental impact of medical devices. When an endoscopy company advertises its commitment to sustainability, it often emphasizes grand visions of solar power and recycling. Should we be impressed? Not necessarily. The elephant in the room is the carbon emissions from the value chain. In fact, 82% of healthcare emissions come from the supply chain of medical devices [2].

What was not highlighted in the study by López-Muñoz et al. is the significant contribution of electronic components (e.g. semiconductors, wires, etc.), which are typically manufactured by suppliers and then assembled into each SUD at a local plant. These components require substantial amounts of energy and water to manufacture, are often transported across continents, and are challenging to recycle after use. It is no surprise that electronic components account for most of the emissions from an SUD [3]. Recycling itself is tricky; in many countries, there is no third-party accountability for best practices and, in certain instances, recycling electronic components can emit more pollution than producing new ones [4].

By neglecting Scope 3 emissions, we risk overlooking substantial sources of carbon output, thereby undermining efforts to achieve meaningful reductions in the healthcare sectorʼs overall carbon footprint. Addressing this requires a more comprehensive approach to environmental assessments – one that integrates material composition, manufacturing processes, transportation [5], and disposal practices [6]. We look forward to more robust accounting methods, such as using primary data for Scope 3 emissions rather than relying on estimates from industry standards, as currently allowed by the Greenhouse Gas Protocol. Another step forward would be to assign emissions to each medical device, rather than to the entire company.

It was not long ago that we prioritized two factors when deciding which product to use: cost and performance. Now, environmental impact is becoming the third product differentiator for device procurement. Although these suggestions may sound aspirational, they are backed by sound accounting principles [7] and are slowly gaining the attention of companies. The first step is to start engaging with device companies in a spirit of mutual learning and collaboration. Endoscopists, as well as patients, deserve to see these granular data in the public domain to make informed decisions about which products to use.

In conclusion, the study by López-Muñoz et al. challenges us to look beyond the immediate visible impacts of our practices and consider the broader, often hidden, environmental costs. By recognizing and addressing Scope 3 emissions, we can take a significant step toward a more sustainable and environmentally responsible healthcare system.

Publication History

Article published online:
05 November 2024

• References

• 1 López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V. et al. Environmental footprint and material composition comparison of single-use and reusable duodenoscopes. Endoscopy 2024;
• 2 Eckelman MJ, Huang K, Lagasse R. et al. Health care pollution and public health damage in the United States: an. Health Aff (Millwood) 2020; 39: 2071-2079
• 3 Le NNT, Hernandez LV, Vakil N. et al. Environmental and health outcomes of single-use versus reusable duodenoscopes. Gastrointest Endosc 2022; 96: 1002-1008
• 4 Ramanna K, Kirk H. Why recycled materials don’t always generate greener products. Accessed October 16, 2024 at: https://hbr.org/2023/11/why-recycled-materials-dont-always-generate-greener-products
• 5 Lacroute J, Marcantoni J, Petitot S. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 55: 918-926
• 6 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022; 71: 1326-1331
• 7 Kaplan R, Ramanna K. Accounting for climate change. Accessed October 16, 2024 at: https://hbr.org/2021/11/accounting-for-climate-change