Endoscopic En Bloc Vs Piecemeal Resection of Large Colonic Adenomas: Carbon Footprint Post Hoc Analysis of a Randomized Trial.

Abstract

Background and aims: Endoscopy makes a significant contribution to the carbon footprint of healthcare. A randomized trial (RESECT-COLON) demonstrated that endoscopic submucosal dissection (ESD) decreases the recurrence rate of large adenomas (>25 mm) vs piecemeal endoscopic mucosal resection (P-EMR), reducing the need for follow-up colonoscopy. We aimed to compare the carbon footprint of those 2 strategies.

Methods: Devices used for both procedures were collected prospectively for each of the 359 patients. P-EMR and ESD were assessed using the life cycle assessment, evaluating 4 parameters: endoscopes and disposable medical products, electricity consumption, anesthetic products, and patient transport. The carbon footprint of the follow-up was simulated in both arms with different scenarios. We performed a post hoc analysis of the carbon footprint of these 2 strategies over 18 months.

Results: Carbon footprint of a single P-EMR procedure was 63.5 kg carbon dioxide equivalent (CO2e) vs 73.2 kg CO2e for ESD (half for patient transport). Including follow-up in local centers, P-EMR generates 93.5 kg CO2e and ESD 76.3 kg CO2e, corresponding to an absolute reduction of 17 kg CO2e (18%) per procedure for ESD. Simulating a strategy of P-EMR resection and follow-up both performed in local centers, the global impact with 18 months follow-up would be 67.3 kg CO2e, favoring P-EMR over ESD.

Conclusions: ESD strategy for lesions over 25 mm could reduce the environmental impact by reducing the associated follow-up colonoscopies and transports of patients. If P-EMR could be performed in local centers with similar quality, results would be in favor of local P-EMR.