Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature

BACKGROUND AND AIMS

Greenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity.

DESIGN

The GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded.

RESULTS

Our search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions.

CONCLUSIONS

Recognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.

Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia

Background

Dyspeptic symptoms are common and mainly due to functional dyspepsia (FD). The Rome IV criteria mandate a normal upper gastrointestinal (UGI) endoscopy before diagnosing FD. However, endoscopies are costly, resource-intensive procedures that generate substantial waste. Hence, simpler means of diagnosing FD are desirable.

Objectives

To determine what proportion of UGI endoscopies are represented by patients with symptoms compatible with Rome IV FD, and the diagnostic yield in this cohort stratified according to alarm features.

Methods

Adult patients attending a UK centre for outpatient UGI endoscopy completed a preprocedure questionnaire on demographics, medical history, alarm features, mood, somatisation and GI symptoms. Alarm features were defined as age ≥55 years, dysphagia, anaemia, unintentional weight loss, UGI bleed or a family history of UGI cancer. Clinically significant endoscopic findings were cancers, Barrett's oesophagus, erosive oesophagitis, peptic ulcers or strictures.

Results

Of 387 patients attending for an outpatient non-surveillance diagnostic UGI endoscopy, 221 had symptoms compatible with FD whereas 166 did not. Approximately 80% in both groups had alarm features, with a similar prevalence of clinically significant endoscopic findings at ~10%. UGI endoscopy was normal in a cohort of 9% (n=35) with symptoms compatible with FD and no alarm features, while benign peptic ulcer was noted in two of 29 cases without FD symptoms and no alarm features.

Conclusion

1-in-10 UGI endoscopies are performed in patients with symptoms compatible with FD and no alarm features, in whom there is no diagnostic yield. We recommend such patients receive a positive diagnosis of FD without endoscopy.