Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature

Abstract

Background and aimsGreenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity.DesignThe GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded.ResultsOur search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions.ConclusionsRecognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.

Green endoscopy, one step toward a sustainable future: Literature review

“…A 2022 systematic review summarized the available literature and found only 9 full fulllength articles. This indicates an urgent need for collecting systematic data on GI endoscopy emissions worldwide [15].…”

Unmet research needs in sustainable luminal gastroenterology practice

“…Expert consensus guidelines from various gastrointestinal societies have also been published, predominantly addressing issues related to endoscopy but also to the clinical practice of gastroenterology. [2][3][4] However, there are a number of unmet research needs in this field, and the evidence base for the recommendations in various guidelines, including the strategies for implementation of GHG reduction, is not very robust. There are very few randomised controlled trials evaluating the impact of one strategy over another.…”