Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

Abstract

Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.

Conflict of interest statement

M. Arvanitakis is providing consultancy to Ambu (September 2021 to September 2022). E. Bak is Chair of the Polish Society of Endoscopic Nurses and Assistants (from 2019, ongoing). M. Dinis-Ribeiro has provided consultancy to Medtronic (from 2021 and Roche (from 2022); his department has received a research grant (loan) from Fujifilm (2021–2022); he is Co-Editor-in-Chief of Endoscopy journal. A. Eickhoff has provided consultancy to Ambu Medical (2012–2020). L. Donnelly is an elected member of the British Society of Gastroenterology – Nurses Association (2022, ongoing). C. Hassan has provided consultancy to and/or received research grants from Alfasigma, Fujifilm, Medtronic, Norgine, Olympus, and Pentax. B.H. Hayee is receiving grant support for sustainability research from Boston Scientific (from April 2022 for 24 months). M.F. Kaminski has provided consultancy to Olympus and Erbe (from 2021), and lectured for Boston Scientific (from 2016) and Recordati (from 2020). H. Messmann has received consultation fees from Ambu, Boston Scientific, and Olympus (in the past 3 years); his department has received financial support from Olympus and Satisfai. M. Pellisé has provided consultancy to Norgine Iberia (2015–2019), CI Supply (2019), and Fujifilm Europe (from 2021, ongoing); her department has received research support from Fujifilm Spain (2019), Fujifilm Europe (from 2020, ongoing), Casen Recordati (2020), ZiuZ (2021), and 3D-Matrix (2022); she is Chair of the ESGE Diversity and Equity Working Group (2021–2022) and a Councillor for SEED (Sociedad Española de Endoscopia Digestiva) (2016–2022). H. Pohl is Co-Editor-in-Chief of Endoscopy journal. E. Rodríguez de Santiago receives support for academic and educational activities with Olympus (from 2021, ongoing); his department receives support for academic and educational activities with Olympus, Boston Scientific, Casen Recordati, and Norgine (from 2016, ongoing). P.D. Siersema receives research support from Pentax, Japan (from 2019), The E-Nose Company, Netherlands (from 2018), Lucid Diagnostics, US (from 2021), MicroTech, China (from 2019), and Magentiq Eye, Israel (from 2021); he receives research support from and advises Motus GI, US (from 2018), and support from Endo Tools Therapeutics, Belgium (2022); he is Editor-in-Chief of Endoscopy journal. A. Veitch has received speaker’s fees from Olympus (March 2022). G.J. Webster has received honoraria for teaching from Boston Scientific (2010–2022). D. Agrawal, R. Baddeley, U. Beilenhoff, P. Bhandari, R. Bisschops, M. Bretthauer, P. Burga, I.M. Gralnek, K. Karlović, V. Lorenzo-Zuniga, M. Pioche, K. Siau, W. Stableforth, T.C. Tham, K. Triantafyllou, A. Tringali, A. Vienne, and A. Voiosu have no competing interests.

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