WEO Newsletter: Towards a Green Endoscopy

Cesare Hassan^1,2 Maddalena Menini¹ and Alessandro Repici^1,2

¹IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy and ²Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

Correspondence: Cesare Hassan, Humanitas Research Hospital and University, Via Manzoni 56, 20089 Rozzano (Milano) Italy, Tel: +39 (0)282247385, Fax: +390282242595, Email: [email protected]

When we think of endoscopy, we think of innovation, advanced techniques, patient safety, and more. But have we ever stopped to reflect on the environmental price of these accomplishments? Could our practices be harmful to the planet's health?

To put the issue into perspective, healthcare contributes between 1% and 5% of global environmental impacts, depending on the metric considered, and surpasses 5% in certain national contexts.¹

Digestive endoscopy is far from blameless as it is a resource-demanding activity with a substantial but insufficiently evaluated environmental footprint.² Endoscopy is believed to be the third-largest producer of waste within the healthcare sector.³

From the gallons of water and kilowatts of energy used in scope reprocessing to the mountains of single-use plastics discarded daily, our practices are leaving a footprint that can no longer be ignored.

A single reusable endoscope, over its lifecycle, emits several kilograms of CO2 for every procedure it undergoes—an unsettling irony for a tool designed to save lives. And while single-use devices are often marketed as convenient and hygienic, they create a staggering amount of non-biodegradable waste.

As endoscopists, we pride ourselves on our ability to solve complex problems, yet we seem reluctant to address one staring us in the face: the unsustainable environmental impact of our work. One could argue that environmentally friendly practices should focus on other sectors rather than healthcare, as patient safety – and healthcare quality - must always come first. Similarly, it could be argued that healthcare workers should direct their attention to advancing care rather than worrying about “recycling waste.”

However, these views are outdated. What could be more urgent than securing our survival on this planet? And is it truly the case that green endoscopy initiatives would compromise the quality of care? Often, energy-intensive and environmentally harmful practices arise not from necessity but from a lack of awareness—or simple negligence and inattention.

It's easy to dismiss these issues as beyond our control, but that mindset is part of the problem. The encouraging news is that practical, sustainable solutions are within reach. Leading societies in Gastrointestinal Endoscopy emphasize sustainability in their practices. ESGE advocates reducing single-use devices, embedding sustainability in training, and aligning with EU net-zero targets by 2050.⁴ ASGE promotes “Green Teams” to implement scalable 3Rs (i.e., Reduce, Reuse, and Recycle) initiatives and align with U.S. policies.^5-8 BSG focuses on minimizing unnecessary procedures, supporting NHS net-zero goals by 2040, and integrating sustainability into training.⁹ APSDE highlights the need for policies, tools to measure carbon footprints, and collaboration with industry to address sustainability challenges.¹⁰ Together, these recommendations aim to reduce the environmental impact of endoscopy while maintaining quality care.

However, these initiatives must be both practical and consistently monitored. Much like in our homes, placing recycling bins is a step forward, but without proper education on sorting and adequate oversight, the effort loses its effectiveness.

As healthcare professionals committed to improving lives, it's time to broaden our definition of “care.” Sustainability is not a luxury—it is an ethical obligation. Patients trust us to safeguard their health; shouldn't we also protect the environment they depend on?

Let's lead the charge toward green endoscopy, not because it's simple, but because it's essential. The question isn't whether we can afford to act but whether we can afford not to. Are you ready to step up? The future of healthcare—and the planet—depends on it.