Rising concern about health care’s climate impact has cast a spotlight on endoscopy, one of the system’s most resource-intensive, high-volume specialties. In Gastrointestinal Endoscopy, the American Society for Gastrointestinal Endoscopy (ASGE) Task Force on Sustainable Endoscopy presents the third installment in its “Practical steps to green your endoscopy unit” series, focusing on the principle of “reduce.”
In the article, first author Daniel von Renteln, MD, of the University of Montreal, and colleagues emphasize that reducing unnecessary procedures, supplies, and ancillary resources offers the greatest environmental benefit relative to effort. The authors argue that sustainability begins with appropriateness. Data cited in the review suggest that 17%–25% of post-polypectomy surveillance colonoscopies are performed too early, while up to half of repeat upper endoscopies may be low yield or inappropriate. Beyond cost and capacity strain, inappropriate endoscopy carries a measurable carbon burden; in Europe alone, low-value upper and lower endoscopies account for more than 30,000 metric tons of CO₂ annually.
The task force highlights adherence to existing ASGE, ACG, and Choosing Wisely recommendations as a cornerstone of environmental stewardship. Alternatives such as fecal immunochemical testing for colorectal cancer screening, calprotectin or intestinal ultrasound for inflammatory bowel disease monitoring, and nonendoscopic approaches to Barrett’s screening are presented as lower-carbon options when clinically appropriate.
Beyond procedure selection, the article details opportunities to reduce waste within the endoscopy suite. These include consolidating same-day procedures, minimizing the number of instruments opened, avoiding low-yield biopsies, and reducing the number and size of pathology specimen jars. Sedation practices also come under scrutiny, with encouragement to use moderate sedation instead of monitored anesthesia care when feasible and to avoid inhaled anesthetics when general anesthesia is required.
The authors frame sustainability as compatible with quality and patient safety. “Being green means performing endoscopies of the highest quality (high value) at the lowest environmental cost,” they wrote. While net-zero endoscopy is unrealistic, the task force concludes that collective, incremental changes, supported by education, triage systems, and institutional engagement, can meaningfully reduce emissions while preserving high standards of care.
Source: Gastrointestinal Endoscopy
