Esophagus to Small Intestine

Gut. 2023;72(9):1692–7

López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V, Vilariño-Feltrer G, Tort-Ausina I, Vidaurre A, Pons Beltran V

Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact


Objectives: Gastrointestinal endoscopy units represent the third largest producers of medical waste. The authors aimed to determine endoscopic instrument composition and life cycle assessment (LCA) and to assess a sustainability proposal based on a mark on the instruments that identifies parts can be safely recycled or ’green mark’.
Design: Material composition analysis and LCA of forceps, snares and clips from 4 different manufacturers (A–D) were performed with 4 different methods. Carbon footprint from production, transportation and end of life of these instruments was calculated. In 30 consecutive procedures, the authors marked the contact point with the working channel. Five centimeters away from that point was considered as green mark. One-week prospective study was conducted with 184 procedures evaluating 143 instruments (75 forceps, 49 snares and 19 hemoclips) to assess the efficacy of this recyclable mark.
Results: Composition from different manufacturers varied widely. Most common materials were high global warming potential (GWP) waste (polyethylene, polypropylene and acrylonitrile) and low GWP waste (stainless steel). Significant differences were found for the forceps (0.31–0.47 kg of CO2 equivalent [CO2-eq]) and hemoclips (0.41–0.57 kg CO2-eq) between the manufacturers. Green mark was established 131.26 cm for gastroscope and 195.32 cm for colonoscope. One-week activity produced 67.74 kg CO2-eq. Applying their sustainability intervention, the authors could reduce up to 27.44% (18.26 kg CO2-eq). This allows the recycling of 61.7% of the instrument total weight (4.69 kg).

Conclusion: Knowledge of carbon footprint is crucial to select the most sustainable alternatives because there are large variations between brands. A mark to identify recyclable parts could reduce our environmental impact significantly.

Prof. Dr. V. Lorenzo-Zúñiga, La Fe University and Polytechnic Hospital, Valencia, Spain, E-Mail: vlorenzozuniga@gmail.com

DOI: 10.1136/gutjnl-2023-329544

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