#GUT Blog: Green Endoscopy: British Society of Gastroenterology (BSG), Joint Advisory Group for Endoscopy (JAG) and Centre for Sustainable Health (CSH) Joint Consensus on practical measures for environmental sustainability in endoscopy

Professor El-Omar has chosen Professor Shaji Sebastian and Professor Anjan Dhar to do the next #GUTBlog. Professor Sebastian is from the Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK and Professor Dhar is from the Department of Gastroenterology, Darlington Memorial Hospital, Darlington.  The #GUTBlog focusses on the paper “Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy” which was published in paper copy in GUT in January 2023.

                 Professor Dhar (L) and Professor Sebastian (R)


Professor Sebastian and Professor Dhar write:

“We are delighted to be invited by Professor Emad El Omar, the Editor in Chief of GUT to write a #GUTBlog on our recent publication on practical measures for environmental sustainability in endoscopy. The last few years have seen a significant increase in the awareness among healthcare providers to reduce the “greenhouse gas” effect of endoscopy, as part of the overall strategy to make Gastroenterology and Hepatology more sustainable. The British Society of Gastroenterology (BSG) was the first among professional organisations to unveil a Strategy on Climate Change and Sustainability in 2021, which aligns to the United Kingdom National Health Service (NHS) ambition to achieve net zero status by circa 2040. The strategy aimed to lay out objective steps to improve sustainability, especially in endoscopy, which is the third highest generator of waste in the healthcare sector.

There remains significant gaps in our knowledge in quantifying the negative environmental impact of each of the tools and procedures in an endoscopy unit. In addition, there is limited published literature identifying measures to mitigate the greenhouse gas impact of multiple processes in Endoscopy. We therefore decided to use a multi-stakeholder working group of gastrointestinal endoscopists, endoscopy nurses and researchers to create consensus statements on specific measures that could be implemented to make the practice of endoscopy more sustainable. The Working Group members were divided into 4 groups to mirror the ‘endoscopy journey’.  Statements were generated from PICOs, and consensus was achieved by two rounds of eDelphi voting at a threshold of 80% for acceptance. Each statement was supported by evidence where this was available.

We have emphasised the principle of the 3R’s (Reduce, Reuse, Recycle) as being the ‘low hanging fruit’ that all endoscopy services should focus upon in the first wave of steps to take for sustainability. Alternative strategies to reduce the number of endoscopies with the goal of `right procedure for the right patient at the right time` with effective clinician led triage is the first way to minimise the ultimate eCO2 contribution of each unit. We discuss the role of non-endoscopic diagnostic tools such as faecal calprotectin, capsule endoscopy, and cytosponge and CT colonoscopy to achieve this goal. The consensus statements address issues around digitisation of endoscopy booking, referrals, reporting, patient information leaflets, and staff communication. We also recommend minimising the use of plastic consumables, sterile water for flushing pumps, unnecessary biopsies and histology pots and disposable personal protective equipment.

The document also discusses the pros and cons of using single use endoscopes, proposing to avoid their use especially for low risk procedures like gastroscopy and colonoscopy. Water exchange colonoscopy is recommended to minimise the use of both CO2 for insufflation and nitrous oxide for patient analgesia. Finally the document recommends reduction of energy consumption from the use of automated taps, motion controlled lighting, switching off computers and printers at night, and increase recycling. We provide useful infographics on waster segregation, and designing a Green endoscopy unit. We also recommend several areas where research needs to be done to build the evidence for sustainability in endoscopy and call own devise manufacturers to position sustainability at the centre of their future innovations and urge procurement teams to scrutinise environmental credentials of manufacturers.

This practical guide is one of many such publications on the theme of ‘Green Endoscopy’, but we feel that it is the first one to collate the possible actions that endoscopy units can take from start to finish for an endoscopic procedure and we hope will benefit units around the world and ultimately our planet at large. This will become the basis of the ‘Green endoscopy check list’ which will be developed for implementation in all endoscopy units.  The document is a collaborative effort of many individuals, all of whom share a passion to improve the greenhouse gases impact of our endoscopy professional environment.”

Social Media:

Professor Dhar @anjan_dhar6

Professor Sebastian @ibdseb

Green Endoscopy @GreenEndoscopy

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