The Difference in Carbon Footprint Between Diagnostic Upper GI Endoscopy in Dyspeptic Patients Versus Therapeutic Upper GI Bleeding

THE DIFFERENCE IN CARBON FOOTPRINT BETWEEN DIAGNOSTIC UPPER GI ENDOSCOPY IN DYSPEPTIC PATIENTS VERSUS THERAPEUTIC UPPER GI BLEEDING

The goal of this observational study is to learn about the carbon footprint produced from diagnostic upper GI endoscopy in patients with dyspepsia and therapeutic upper GI endoscopy in patients with non-variceal upper GI bleeding. The main question it aims to answer is:

• How much carbon footprint is generated from upper GI endoscopy Participants are already receiving diagnostic and therapeutic upper GI endoscopy as part of their regular medical care for dyspepsia and non-variceal upper GI bleeding, respectively. The carbon footprint generated from this treatment process is examined.

Study Overview

• Status: Recruiting
• Conditions: Dyspepsia; Non-variceal Upper Gastrointestinal Bleeding; Carbon Footprint in Upper GI Endoscopy

Detailed Description

Healthcare systems are a significant source of greenhouse gas (GHG) emissions. Gastrointestinal endoscopy accounts for the third largest share of GHG emissions among hospital services, after anesthesiology and intensive care units. Upper GI endoscopy is commonly indicated for diagnostic purposes, such as dyspepsia, or for therapeutic purposes, such as upper GI bleeding. Carbon footprint is defined as the total amount of GHG emissions over the life cycle of a service or product. Prior studies have primarily estimated the overall footprint of endoscopy, often including indirect sources such as patient transportation, rather than direct emissions. To date, no studies have compared the carbon footprint between diagnostic and therapeutic upper GI endoscopy.

This study aims to provide a detailed assessment of the direct carbon footprint generated by endoscopic procedures. We hypothesize that therapeutic endoscopy for upper GI bleeding has higher carbon emissions due to longer procedure time, greater energy consumption, and increased use of disposable equipment compared to diagnostic endoscopy for dyspepsia.

This study is an observational study looking at patients with dyspepsia and peptic ulcer bleeding coming to receive diagnostic and therapeutic upper GI endoscopy, respectively. Patients coming to receive an upper GI endoscopy at King Chulalongkorn Memorial Hospital and Sawanpracharak Hospital, Thailand, who are under the inclusion criteria, are asked to get enrolled in the study and have their data recorded. Without any intervention, they will be treated with the standard treatment and investigation for their conditions.

The timeframe for patient enrollment is two months. The carbon footprint produced was calculated from medical equipment and medication used, energy consumption, and equipment reprocessing. The carbon footprint produced was calculated from when the patient entered the endoscopy center until they left the endoscopy center.

Patients with peptic ulcer bleeding will either get treatment with a bipolar hemostasis probe, a hemostasis clip, or argon plasma coagulation. Epinephrine injection can also be used as an adjunctive treatment.

The success rate and complications after treatment in patients with peptic ulcer bleeding will be recorded by follow-up at 72 hours and 30 days after the procedure.

The data recorded in this study are age, height, weight, underlying diseases, history of alcohol consumption, history of smoking, duration of endoscopic procedure, types and locations of peptic ulcer (if any) according to Forrest classification, and the success rate of bleeding stoppage. These data will be used to calculate the carbon footprint produced from upper GI endoscopy.

Categorical data will be processed using the chi-square test. Continuous data will be calculated using mean and standard deviation, and compared using the unpaired t-test and ANOVA test.

• Study Type: Observational
• Enrollment (Estimated): 75

Contacts and Locations

• Study Contact: Name: Ponthakorn Pichayanont, Doctor of Medicine; Phone Number: 66831237704; Email: ponthakorn.pi@gmail.com

Study Locations

• Thailand
  • Bangkok, Thailand, 10330
    • Recruiting
    • King Chulalongkorn Memorial Hospital
    • Contact: Ponthakorn Pichayanont, Doctor of Medicine; Phone Number: 66831237704; Email: ponthakorn.pi@gmail.com
  • Nakhon Sawan, Thailand, 60000
    • Recruiting
    • Sawanpracharak Hospital
    • Contact: Natee Faknak, Doctor of Medicine; Phone Number: 66849961424; Email: f.natee30@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Dyspepsia patients and non-variceal upper GI bleeding receiving upper GI endoscopy at King Chulalongkorn Memorial hospital and Sawanpracharak hospital, Thailand

Description

Inclusion Criteria:

• Patients with dyspepsia or non-variceal upper GI bleeding
• Age 20-80 years
• Body mass index of 30 or less;
• Receiving one of the following procedure during upper GI endoscopy:

For diagnostic endoscopy: Rapid urease test for H. pylori infection For therapeutic endoscopy: stop bleeding with either Argon plasma coagulation or Bipolar hemostasis probe or Hemostasis clip

Exclusion Criteria:

• Platelet < 50,000
• INR > 2.5
• Pregnancy
• History of allergy to IV sedative medication
• Peptic ulcer grade IIc and III according to Forrest classification
• Patient receiving inhalation anesthesia

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Diagnostic upper GI endoscopy; Dyspepsia patient receiving diagnostic upper GI endoscopy
Therapeutic upper GI endoscopy; Non-variceal upper GI bleeding patient receiving therapeutic upper GI endoscopy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To quantify the carbon footprint of diagnostic endoscopy for dyspepsia and therapeutic endoscopy for peptic ulcer bleeding	The primary outcome is to calculate the carbon footprint produced from diagnostic upper GI endoscopy in dyspepsia patients and therapeutic upper GI endoscopy in peptic ulcer patients, focusing on the carbon footprint produced since the patient enter the endoscopy room until they leave the endoscopy room	From enrollment to the time that patients leave the endoscopy room

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To compare carbon emissions between diagnostic and therapeutic upper GI endoscopy		From enrollment to the time that patients leave the endoscopy room
To compare emissions across different hemostatic techniques (clips, argon plasma coagulation, bipolar probe), with or without epinephrine.		From enrollment to the time that patients leave the endoscopy room
To evaluate procedural success rates of bleeding stoppage and adverse events (e.g., perforation, post-procedural sepsis) by different techniques	To evaluate procedural success rates of bleeding stoppage and adverse events (e.g., perforation, post-procedural sepsis) by different techniques (follow up to 30 days after treatment was given to see rate of recurrent bleeding)	From enrollment to 30 days after treatment

Collaborators and Investigators

• Sponsor: King Chulalongkorn Memorial Hospital

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Actual): August 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: November 21, 2025
• First Submitted That Met QC Criteria: November 21, 2025
• First Posted (Estimated): December 3, 2025

Study Record Updates

• Last Update Posted (Estimated): December 3, 2025
• Last Update Submitted That Met QC Criteria: November 21, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: EGD; Dyspepsia; Upper GI endoscopy; Carbon footprint; Non-variceal upper gastrointestinal bleeding
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Dyspepsia
• Other Study ID Numbers: RP027

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No