Esophagus to Small Intestine

Gastroenterology. 2024;166(3):496–502.e3

Desai M, Campbell C, Perisetti A, Srinivasan S, Radadiya D, Patel H, Melquist S, Rex DK, Sharma P

The environmental impact of gastrointestinal procedures: A prospective study of waste generation, energy consumption, and auditing in an endoscopy unit

Background and aims: Gastrointestinal endoscopy procedures are critical for screening, diagnosis, and treatment of a variety of gastrointestinal disorders. However, like the procedures in other medical disciplines, they are a source of environmental waste generation and energy consumption.
Methods: The authors prospectively collected data on total waste generation, energy consumption, and the role of intraprocedural inventory audit of a single tertiary care academic endoscopy unit over a 2-month period (May–June 2022). Detailed data on items used were collected, including procedure type (esophagogastroduodenoscopy or colonoscopy), accessories, intravenous tubing, biopsy jars, linen, and personal protective equipment use. Data on endoscope reprocessing-related waste generation and energy use in the endoscopy unit (equipment, lights, and computers) were also collected. An endoscopy staff-guided auditing and review of the items used during procedures was used to determine potentially recyclable items going to landfill waste. The waste generated was stratified into biohazardous, non-biohazardous, or potentially recyclable items.
Results: A total of 450 consecutive procedures were analyzed for total waste management (generation and reprocessing) and energy consumption. The total waste generated during the study period was 1398.6 kg (61.6% directly going to landfill, 33.3% biohazard waste, and 5.1% sharps), averaging 3.03 kg/procedure. The average waste directly going to landfill was 219 kg per 100 procedures. The estimated total annual waste generation approximated the size of 2 football fields (1-foot-high layered waste). Endoscope reprocessing generated 194 gallons of liquid waste per day, averaging 13.85 gallons per procedure. Total energy consumption in the endoscopy unit was 277.1 kWh energy per day; for every 100 procedures, amounting to 1200 miles of distance traveled by an average fuel efficiency car. The estimated carbon footprint for every 100 gastrointestinal procedures was 1501 kg carbon dioxide (CO2) equivalent (= 1680 lbs of coal burned), which would require 1.8 acres of forests to sequester. The recyclable waste audit and review demonstrated that 20% of total waste consisted of potentially recyclable items (8.6 kg/day) that could be avoided by appropriate waste segregation of these items.

Conclusions: On average, every 100 gastrointestinal endoscopy procedures (esophagogastroduodenoscopy/colonoscopy) are associated with 303 kg of solid waste and 1385 gallons of liquid waste generation, and 1980 kWh energy consumption. Potentially recyclable materials account for 20% of the total waste. These data could serve as an actionable model for health systems to reduce total waste generation and decrease landfill waste and water waste toward environmentally sustainable endoscopy units.

P. Sharma, M.D., Professor of Medicine, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, USA, E-Mail:

DOI: 10.1053/j.gastro.2023.12.006

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