PHILADELPHIA—Procedural changes in the hospital setting have the potential to significantly reduce the environmental impact of endoscopic procedures, without compromising patient care, according to study data announced at ACG 2024.  

Rajmohan Rammohan, MD, a gastroenterology fellow at Nassau University Medical Center (NUMC), in East Meadow, N.Y., led a two-phase study of endoscopic procedures performed at the center over one year, measuring environmental impacts before and after implementing specific interventions. By optimizing energy use, adopting reusable tools and using eco-friendly technologies, he and his co-investigators were able to achieve a significant reduction in the carbon footprint and Global Warming Potential (GWP) associated with NUMC’s endoscopy procedures.

 

Healthcare comprises about 8.5% of greenhouse gas emissions in the United States, according to the National Academy of Medicine. Gastroenterology contributes disproportionally to this figure due to energy-intensive sterilization procedures as well as ubiquitous single-use plastics and anesthetic agents, Dr. Rammohan told Gastroenterology & Endoscopy News. This has prompted many GI experts, including Dr. Rammohan, to call for more environmentally sustainable healthcare practices.

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The study included 1,367 colonoscopies, 1,338 endoscopies and 39 endoscopic retrograde cholangiopancreatographies at a high-volume clinic that averages 53 procedures per week (abstract P0663). In the first phase of the study, the investigators assessed carbon output from consumables, energy and transport from June to December 2023. 

Consumables, energy and transport “were vital in calculating the carbon footprint and Global Warming Potential of the procedures,” Dr. Rammohan said, noting that “challenges in quantifying carbon output included [difficulty] gathering accurate data on consumables and assessing the direct and indirect emissions from energy and transport.”

Staff then received training on methods to help reduce the environmental impact of endoscopy procedures. Areas of focus for training included an emphasis on using reusable instruments when possible; implementing more efficient sterilization techniques that use fewer chemicals and less energy; properly segregating waste; using sustainable consumables, such as drapes and covers, and minimizing plastics; and locally sourcing, when possible, to minimize transportation-related emissions.

During the study’s second phase, which ran from January to June 2024, the investigators calculated carbon data and measured the GWP. The investigators used the Bilan Carbone protocol and data from the U.S. Energy Information Administration to calculate annual footprints and paired t tests to analyze the differences between the pre- and post-training periods.

After intervention, investigators found a significant reduction in CO₂ emissions from electricity, from 5,760 to 3,100 kg (P<0.035). In addition, they found there was a notable reduction in instrument use, from 1,550 to 1,011 instruments (P<0.021). These efforts collectively reduced the overall carbon footprint from 2,387,708 to 1,311,308 MTCO₂e (metric tons of carbon dioxide equivalent) (P=0.0402) and improved the GWP from 2.6±1.3 to 1.3±0.7 (P=0.000016).

Dr. Rammohan acknowledged that the size and type of a center might influence the scalability and impact of such green initiatives. Smaller centers may face challenges in implementing extensive changes due to limited resources, whereas larger centers might have more capacity but also bigger footprints to manage. However, he stressed that every effort counts if it contributes to more environmentally sustainable healthcare.

“Targeted interventions that do not compromise patient care but significantly contribute to sustainability are important,” Dr. Rammohan said. “The crucial factor is commitment across all staff levels and embedding sustainable practices into routine procedures.”

—Katie Prince