Time is over: Step back to reusable and step forward to recyclable!

We read with deep interest the position paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO) [ [1] Bortoluzzi F. Sorge A. Vassallo R. et al. Sustainability in gastroenterology and digestive endoscopy: position paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO). Dig Liver Dis. 2022; 54: 1623-1629 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ] reviewing the environmental impact of gastroenterology and digestive endoscopy. Interestingly the position paper provides information on the carbon footprint of gastroenterology and particularly digestive endoscopy. Impressively, gastroenterology is considered the third largest contributor to waste production in healthcare [ [2] Namburar S. von Renteln D. Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut. 2022; 71: 1326-1331 Crossref PubMed Scopus (33) Google Scholar ]. After a 5-day audit at two US medical centers, Namburar et al. estimated that the total waste generated during all the endoscopic procedures performed in the USA annually weighs 38 000 t and cover 117 soccer fields to 1 m depth. Considering also the endoscopes reprocessing, the total waste weight increases to 43,500 t [ [2] Namburar S. von Renteln D. Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut. 2022; 71: 1326-1331 Crossref PubMed Scopus (33) Google Scholar ]. Moreover, the authors estimated that if all the endoscopies were performed with single-use endoscopes, the total waste mass would increase by 40%. In the position paper by Bortoluzzi F. et al., the authors explore the possible strategies to reduce the carbon footprint in order to create a “green endoscopy”. Reduce, reuse, and recycle are the principles that applied to endoscopy can lead to disease prevention and waste minimization for a more sustainable digestive endoscopy. This approach is interesting, however, to reduce the environmental impact of digestive endoscopy it is mandatory to understand the specific impact of each endoscopic procedure. As a matter of fact, the equipment used during the main endoscopic procedure, such as esophagogastroduodenoscopy (EGD), colonoscopy (CS), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), is widely different also according to the procedure purpose. The environmental impact may change depending on the specific endoscopic procedure and a detailed study of the waste generated during the different endoscopies may help in the journey towards a more sustainable gastrointestinal endoscopy. Table 1Waste mass during the 5-day audit. Total EGD/CS EUS ERCP N of procedures per week, n (%) 390 147 (37.8)/148 (38) 63 (16.2) 32 (8) Waste mass per week, kg (%) 263.9 136.9 (51.9) 45.5 kg (17.3) 81.5 kg (30.8) Waste mass per year, kg 11,611 6023,6 2002 3586 Waste mass per single procedure, kg 1.24 (mean) 0.464 0.722 2.54 EGD: esophagogastroduodenoscopy; CS: colonoscopy; EUS: endoscopic ultrosound; ERCP: endoscopic retrograde cholangiopancreatography. Open table in a new tab EGD: esophagogastroduodenoscopy; CS: colonoscopy; EUS: endoscopic ultrosound; ERCP: endoscopic retrograde cholangiopancreatography. Sustainability in gastroenterology and digestive endoscopy: Position Paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO)Digestive and Liver DiseaseVol. 54Issue 12PreviewClimate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure-dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the ‘triple bottom line’ of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gastroenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Full-Text PDF Author's reply: “Time is over: step back to reusable and step forward to recyclable!”Digestive and Liver DiseaseVol. 55Issue 8PreviewWe would like to thank the Editors of DLD for the opportunity to reply to the comments of Schepis et al. on our recent paper on issues related to sustainability in gastroenterology and digestive endoscopy from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO) [1]. The commentary is of extreme interest, and provides insight into how endoscopic ultrasound (EUS) and retrograde cholangiopancreatography (ERCP) may contribute to the environmental impact of digestive endoscopy [2]. Full-Text PDF