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Pioche M, Pohl H, Cunha Neves JA, Laporte A, Mochet M, Rivory J, Grau R, Jacques J, Grinberg D, Boube M, Baddeley R, Cottinet PJ, Schaefer M, Rodríguez de Santiago E, Berger A. Environmental impact of single-use versus reusable gastroscopes. Gut 2024:gutjnl-2024-332293. [PMID: 39122363 DOI: 10.1136/gutjnl-2024-332293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The environmental impact of endoscopy is a topic of growing interest. This study aimed to compare the carbon footprint of performing an esogastroduodenoscopy (EGD) with a reusable (RU) or with a single-use (SU) disposable gastroscope. METHODS SU (Ambu aScope Gastro) and RU gastroscopes (Olympus, H190) were evaluated using life cycle assessment methodology (ISO 14040) including the manufacture, distribution, usage, reprocessing and disposal of the endoscope. Data were obtained from Edouard Herriot Hospital (Lyon, France) from April 2023 to February 2024. Primary outcome was the carbon footprint (measured in Kg CO2 equivalent) for both gastroscopes per examination. Secondary outcomes included other environmental impacts. A sensitivity analysis was performed to examine the impact of varying scenarios. RESULTS Carbon footprint of SU and RU gastroscopes were 10.9 kg CO2 eq and 4.7 kg CO2 eq, respectively. The difference in carbon footprint equals one conventional car drive of 28 km or 6 days of CO2 emission of an average European household. Based on environmentally-extended input-output life cycle assessment, the estimated per-use carbon footprint of the endoscope stack and washer was 0.18 kg CO2 eq in SU strategy versus 0.56 kg CO2 eq in RU strategy. According to secondary outcomes, fossil eq depletion was 130 MJ (SU) and 60.9 MJ (RU) and water depletion for 6.2 m3 (SU) and 9.5 m3 (RU), respectively. CONCLUSION For one examination, SU gastroscope have a 2.5 times higher carbon footprint than RU ones. These data will help with the logistics and planning of an endoscopic service in relation to other economic and environmental factors.
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Affiliation(s)
| | - Heiko Pohl
- Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | | | | | - Mikael Mochet
- Endoscopy division, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
- Gastroenterology and Endoscopy, Hopital Croix Rousse, Lyon, France
| | | | - Jérémie Jacques
- Gastroenterology, Hopital Dupuytren, Limoges, France
- UMR 7252, CNRS XLIM, Limoges, France
| | - Daniel Grinberg
- Hospices Civils de Lyon, Lyon, France
- Material Analysis Laboratory, Villeurbanne, France
| | | | - Robin Baddeley
- St Mark's the National Bowel Hospital and Academic Institute, London, UK
- Institute for Therapeutic Endoscopy, King's Health Partners, London, UK
| | | | - Marion Schaefer
- Department of Hepatogastroentrology, Nancy Regional University Hospital Center, Nancy, France
| | | | - Arthur Berger
- Department of Gastroenterology and Hepatology, Bordeaux university hospital, Bordeaux, France
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Maida M, Dahiya DS, Shah YR, Tiwari A, Gopakumar H, Vohra I, Khan A, Jaber F, Ramai D, Facciorusso A. Screening and Surveillance of Colorectal Cancer: A Review of the Literature. Cancers (Basel) 2024; 16:2746. [PMID: 39123473 PMCID: PMC11312202 DOI: 10.3390/cancers16152746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Colorectal cancer (CRC) has the highest mortality rate among men and is the second highest among women under fifty, with incidence and mortality rates rising in younger populations. Studies indicate that up to one-third of patients diagnosed before fifty have a family history or genetic factors, highlighting the need for earlier screening. Contrariwise, diagnosis in healthy subjects through screening strategies enables early-stage detection of the tumor and better clinical outcomes. In recent years, mortality rates of CRC in Western countries have been on a steady decline, which is largely attributed to widespread screening programs and advancements in treatment modalities. Indeed, early detection through screening significantly improves prognosis, with stark differences in survival rates between localized and metastatic disease. This article aims to provide a comprehensive review of the existing literature, delving into the performance and efficacy of various CRC screening strategies. It navigates through available screening tools, evaluating their efficacy and cost-effectiveness. The discussion extends to delineating target populations for screening, emphasizing the importance of tailored approaches for individuals at heightened risk.
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Affiliation(s)
- Marcello Maida
- Department of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy;
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Yash R. Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, USA
| | - Angad Tiwari
- Department of Internal Medicine, Maharani Laxmi Bai Medical College, Jhansi 284001, India;
| | - Harishankar Gopakumar
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Ishaan Vohra
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Aqsa Khan
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN 46805, USA;
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, KS 64110, USA;
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Biomedical Science, Foggia University Hospital, 71122 Foggia, Italy
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3
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Klose MA, Becker A, Blank V, Eisenmann S, Rosendahl J, Walldorf J. Role of patient and staff mobility in scope 3 emissions in GI endoscopy. Gut 2024; 73:1232-1234. [PMID: 38418211 DOI: 10.1136/gutjnl-2024-332041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Michelle A Klose
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Antonia Becker
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Valentin Blank
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
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Lorenzo-Zúñiga V. Capsule endoscopy emissions: less than expected and largely influenced by patient transport. Endoscopy 2024. [PMID: 38889750 DOI: 10.1055/a-2336-4320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Gastroenterology and Endoscopy / IIS La Fe, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medicine, Valencia Catholic University Saint Vincent Martyr Faculty of Medicine and Dentistry, Valencia, Spain
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Pioche M, Cunha Neves JA, Pohl H, Lê MQ, Grau R, Dray X, Yzet C, Mochet M, Jacques J, Wallenhorst T, Rivory J, Siret N, Peillet AL, Chevaux JB, Mion F, Chaput U, Jacob P, Grinberg D, Saurin JC, Baddeley R, Rodriguez de Santiago E, Cottinet PJ. The environmental impact of small-bowel capsule endoscopy. Endoscopy 2024. [PMID: 38657660 DOI: 10.1055/a-2313-5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure. METHODS Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts. RESULTS The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43-119 g) accounted for 9 %-97 % of total weight, and included deactivation magnets (5 g [4 %-6 %]) and paper instructions (11-50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2, with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible. CONCLUSION The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions.
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Affiliation(s)
- Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Joao A Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Heiko Pohl
- Departments of Gastroenterology, VA Medical Center, White River Junction, Vermont; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Minh-Quyen Lê
- Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
| | - Raphaelle Grau
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, University Hospital, Amiens, France
| | - Mikael Mochet
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, University Hospital Pontchaillou, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nadège Siret
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Anne-Laure Peillet
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - François Mion
- Digestive Physiology Department, Hospices Civils de Lyon, Lyon, France
| | - Ulriikka Chaput
- Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
| | - Philippe Jacob
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Gastroenterology and Endoscopy Unit, Nimes Private Clinic, Nimes, France
| | - Daniel Grinberg
- Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
- Cardiac Surgery, Cardiologic Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Saurin
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Robin Baddeley
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute; King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital; and Imperial College London, London, UK
| | - Enrique Rodriguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fichtl A, Tacheva V, Sturm N, Hamesch K, Wichmann D, Mayer B, Müller M, Wagner M, Seufferlein T, Walter BM. Impact of power consumption and power saving for GI endoscopy (power on study) on reducing CO 2 emissions. Gut 2024; 73:892-896. [PMID: 38262673 PMCID: PMC11103347 DOI: 10.1136/gutjnl-2023-331867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Anna Fichtl
- Endoscopy Research Unit, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Veronika Tacheva
- Endoscopy Research Unit, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Niklas Sturm
- Endoscopy Research Unit, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Karim Hamesch
- Medical Clinic III - Clinic for Gastroenterology, Metabolic Disorders, and Internal Intensive Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Doerte Wichmann
- Department of General, Visceral and Transplantation Surgery, Interdisciplinary Endoscopy Unit, University Hospitals Tubingen, Tübingen, Baden-Württemberg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Martin Müller
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Martin Wagner
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
| | - Benjamin M Walter
- Endoscopy Research Unit, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Baden-Württemberg, Germany
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8
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Cho JH, Jin SY, Park S. Carbon footprint and cost reduction by endoscopic grading of gastric intestinal metaplasia using narrow-band imaging. J Gastroenterol Hepatol 2024; 39:942-948. [PMID: 38251795 DOI: 10.1111/jgh.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIM Gastric intestinal metaplasia (GIM) is a high-risk factor for the development of gastric cancer. Narrow-band imaging (NBI) enables endoscopic grading of GIM (EGGIM). In the era of climate change, gastrointestinal endoscopists are expected to reduce greenhouse gas emissions and medical waste. Based on the diagnostic performance of NBI endoscopy, this study measured the environmental impact and reduced cost of implementing EGGIM during gastroscopy. METHODS Using NBI endoscopy in 242 patients, EGGIM classification and operative link on GIM (OLGIM) staging were prospectively performed in five different areas (lesser and greater curvatures of the corpus and antrum, and the incisura angularis). We estimated the environmental impact and cost reduction of the biopsy procedures and pathological processing if EGGIM were used instead of OLGIM. RESULTS The diagnostic accuracy of NBI endoscopy for GIM was 93.0-97.1% depending on the gastric area. When a high EGGIM score ≥ 5 was the cut-off value for predicting OLGIM stages III-IV, the area under the curve was 0.862, sensitivity was 81.9%, and specificity was 90.4%. The reduction in the carbon footprint by EGGIM was -0.4059 kg carbon dioxide equivalents per patient, equivalent to 1 mile driven by a gasoline-powered car. The cost savings were calculated to be $47.36 per patient. CONCLUSIONS EGGIM is a reliable method for identifying high-risk gastric cancer patients, thereby reducing the carbon footprint and medical costs in endoscopy practice.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, South Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Suyeon Park
- Department of Medical Biostatistics, Soonchunhyang University Hospital, Seoul, South Korea
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9
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Cunha Neves JA, Rodriguez de Santiago E, Pohl H, Lorenzo-Zúñiga V, Cunha MF, Voiosu AM, Römmele C, Penman DG, Albéniz E, Siau K, Donnelly L, Elli L, Pioche M, Beilenhoff U, Arvanitakis M, Weusten BLAM, Bisschops R, Hassan C, Messmann H, Gralnek IM, Dinis-Ribeiro M. Perspectives and awareness of endoscopy healthcare professionals on sustainable practices in gastrointestinal endoscopy: results of the LEAFGREEN survey. Endoscopy 2024; 56:355-363. [PMID: 38278158 DOI: 10.1055/a-2240-9414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Gastrointestinal (GI) endoscopy is one of healthcare's main contributors to climate change. We aimed to assess healthcare professionals' attitudes and the perceived barriers to implementation of sustainable GI endoscopy. METHODS The LEAFGREEN web-based survey was a cross-sectional study conducted by the European Society of Gastrointestinal Endoscopy (ESGE) Green Endoscopy Working Group. The questionnaire comprised 39 questions divided into five sections (respondent demographics; climate change and sustainability beliefs; waste and resource management; single-use endoscopes and accessories; education and research). The survey was available via email to all active members of the ESGE and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) in March 2023. RESULTS 407 respondents participated in the survey (11% response rate). Most participants (86%) agreed climate change is real and anthropogenic, but one-third did not consider GI endoscopy to be a significant contributor to climate change. Improvement in the appropriateness of endoscopic procedures (41%) and reduction in single-use accessories (34%) were considered the most important strategies to reduce the environmental impact of GI endoscopy. Respondents deemed lack of institutional support and knowledge from staff to be the main barriers to sustainable endoscopy. Strategies to reduce unnecessary GI endoscopic procedures and comparative studies of single-use versus reusable accessories were identified as research priorities. CONCLUSIONS In this survey, ESGE and ESGENA members acknowledge climate change as a major threat to humanity. Further improvement in sustainability beliefs and professional attitudes, reduction in inappropriate GI endoscopy, and rational use of single-use accessories and endoscopes are critically required.
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Affiliation(s)
- João A Cunha Neves
- Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, IRYCIS, Madrid, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Heiko Pohl
- Section of Gastroenterology, Dartmouth College Geisel School of Medicine, Hanover, United States
- Section of Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, United States
| | - Vicente Lorenzo-Zúñiga
- Department of Gastroenterology and Endoscopy unit IIS La Fe, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Miguel F Cunha
- Colorectal Disease Group - Department of General Surgery, Algarve University Hospital Centre, Portimão, Portugal
| | - Andrei M Voiosu
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucuresti, Romania
- Carol Davila University of Medicine and Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | | | - Douglas G Penman
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Eduardo Albéniz
- Endoscopy and Gastroenterology, Hospital Universitario de Navarra (HUN), Pamplona, Spain
- Gastroenterology, Navarrabiomed; Universidad Pública de Navarra (UPNA); IdiSNA, Pamplona, Spain
| | - Keith Siau
- Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom of Great Britain and Northern Ireland
| | - Leigh Donnelly
- Endoscopy Department, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom of Great Britain and Northern Ireland
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Ulrike Beilenhoff
- Endoscopy, ESGENA Scientific Secretariat, Ferdinand- Sauerbruch-Weg 16, 89075 Ulm, Germany
| | | | - Bas L A M Weusten
- Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
- Department of Gastroenterology & Hepatology, Utrecht University, Utrecht, Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Helmut Messmann
- Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Mário Dinis-Ribeiro
- Gastroenterology, Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
- Gastroenterology, RISE@CI-IPOP (Health Research Network), Porto, Portugal
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10
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Tee NCH, Yeo JA, Choolani M, Poh KK, Ang TL. Healthcare in the era of climate change and the need for environmental sustainability. Singapore Med J 2024; 65:204-210. [PMID: 38650058 PMCID: PMC11132617 DOI: 10.4103/singaporemedj.smj-2024-035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
ABSTRACT Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.
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Affiliation(s)
- Nicholas Chin Hock Tee
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jo-Anne Yeo
- Duke-NUS Medical School, Singapore
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Mahesh Choolani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Sonaiya S, Marino R, Agollari K, Sharma P, Desai M. Environmentally sustainable gastroenterology practice: Review of current state and future goals. Dig Endosc 2024; 36:406-420. [PMID: 37723605 DOI: 10.1111/den.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. METHODS A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. RESULTS This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. CONCLUSION Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented.
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Affiliation(s)
- Sneh Sonaiya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Richard Marino
- Kansas City University School of Medicine, Kansas City, USA
| | - Klea Agollari
- Kansas City University School of Medicine, Kansas City, USA
| | | | - Madhav Desai
- Center for Interventional Gastroenterology, UTHealth McGovern Medical School, Houston, USA
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12
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Rosa B, Cúrdia Gonçalves T, Moreira MJ, Dias de Castro F, Sousa-Pinto B, Dinis-Ribeiro M, Cotter J. Pan-intestinal capsule endoscopy as first-line procedure in patients with suspected mid or lower gastrointestinal bleeding. Endoscopy 2024. [PMID: 38365215 DOI: 10.1055/a-2270-4601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Pan-intestinal capsule endoscopy (PCE) evaluates the small bowel and colon noninvasively. This study evaluated diagnostic accuracy and safety of PCE vs. colonoscopy as first-line examination in suspected mid-lower gastrointestinal bleeding (MLGIB). METHODS In this prospective, single-center, single-blinded cohort study, consecutive patients with suspected MLGIB underwent PCE followed by same-day colonoscopy. Diagnostic accuracy for potentially hemorrhagic lesions (PHLs; combined diagnosis by PCE + colonoscopy) and incidence of adverse events were assessed. RESULTS 100 patients were included (median age 70 [range 18-92] years; 65% female). PHLs were diagnosed in 46 patients, including small-bowel and/or colon angioectasias in 32. PCE correctly identified 54 individuals without PHLs, and 95.7% (44/46) of those with PHLs vs. 50.0% (23/46) for colonoscopy (P<0.01). PHLs were detected by PCE alone in 65.2% (30/46), both examinations in 28.3% (13/46), and colonoscopy alone in 6.5% (3/46). PHLs were diagnosed at the ileocolonic region in 28% of patients, with PCE diagnosing 25/28 cases (89.3%) and colonoscopy diagnosing 23/28 (82.1%; P=0.13). Interventional procedures were performed at colonoscopy in 13/81 patients with iron-deficiency anemia (16.0%) vs. 6/19 patients with overt bleeding (31.6%; P<0.01). No significant adverse events occurred with PCE vs. 2% with colonoscopy. CONCLUSIONS In patients with MLGIB, PCE avoided further invasive procedures in >50% of patients. PCE was safe and more effective than colonoscopy in identifying PHL both in the small bowel and colon. These results support the potential use of PCE as first-line examination in patients with suspected MLGIB.
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Affiliation(s)
- Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Maria J Moreira
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Francisca Dias de Castro
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
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13
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Henniger D, Lux T, Windsheimer M, Brand M, Weich A, Kudlich T, Schöttker K, Hann A, Meining A. Reducing scope 3 carbon emissions in gastrointestinal endoscopy: results of the prospective study of the 'Green Endoscopy Project Würzburg'. Gut 2024; 73:442-447. [PMID: 37898548 PMCID: PMC10894835 DOI: 10.1136/gutjnl-2023-331024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Carbon emissions generated by gastrointestinal endoscopy have been recognised as a critical issue. Scope 3 emissions are mainly caused by the manufacturing, packaging and transportation of purchased goods. However, to our knowledge, there are no prospective data on the efficacy of measurements aimed to reduce scope 3 emissions. DESIGN The study was performed in a medium-sized academic endoscopy unit. Manufacturers of endoscopic consumables were requested to answer a questionnaire on fabrication, origin, packaging and transport. Based on these data, alternative products were purchased whenever possible. In addition, staff was instructed on how to avoid waste. Thereafter, the carbon footprint of each item purchased was calculated from February to May 2023 (intervention period), and scope 3 emissions were compared with the same period of the previous year (control period). RESULTS 26 of 40 companies answered the questionnaire. 229 of 322 products were classified as unfavourable. A switch to alternative items was possible for 47/229 items (20.5%). 1666 endoscopies were performed during the intervention period compared with 1751 examinations during the control period (-4.1%). The number of instruments used decreased by 10.0% (3111 vs 3457). Using fewer and alternative products resulted in 11.5% less carbon emissions (7.09 vs 8.01 tons of carbon equivalent=tCO2 e). Separation of waste led to a reduction of 20.1% (26.55 vs 33.24 tCO2e). In total, carbon emissions could be reduced by 18.4%. CONCLUSION Use of fewer instruments per procedure, recycling packaging material and switching to alternative products can reduce carbon emissions without impairing the endoscopic workflow.
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Affiliation(s)
- Dorothea Henniger
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Thomas Lux
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | | | - Markus Brand
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Alexander Weich
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Theodor Kudlich
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Katrin Schöttker
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Alexander Hann
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Alexander Meining
- Department of Gastroenterology, University of Würzburg, Würzburg, Germany
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14
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Martín-Cabezuelo R, Vilariño-Feltrer G, Campillo-Fernández AJ, Lorenzo-Zúñiga V, Pons V, López-Muñoz P, Tort-Ausina I. Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use. ACS ENVIRONMENTAL AU 2024; 4:42-50. [PMID: 38250342 PMCID: PMC10797683 DOI: 10.1021/acsenvironau.3c00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Ironically, healthcare systems are key agents in respiratory-related diseases and estimated deaths because of the high impact of their greenhouse gas emissions, along with industry, transportation, and housing. Based on safety requirements, hospitals and related services use an extensive number of consumables, most of which end up incinerated at the end of their life cycle. A thorough assessment of the carbon footprint of such devices typically requires knowing precise information about the manufacturing process, which is rarely available in detail because of the many materials, pieces, and steps involved during the fabrication. Yet, the tools most often used for determining the environmental impact of consumer goods require a bunch of parameters, mainly based on the material composition of the device. Here, we report a basic set of analytical methods that provide the information required by the software OpenLCA to calculate the main outcome related to environmental impact, greenhouse gas emissions. Through thermogravimetry, calorimetry, infrared spectroscopy, and elemental analysis, we proved that obtaining relevant data for the calculator in the exemplifying case of endoscopy tooling or accessories is possible. This routine procedure opens the door to a broader, more accurate analysis of the environmental impact of everyday work at hospital services, offering potential alternatives to minimize it.
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Affiliation(s)
- Rubén Martín-Cabezuelo
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Guillermo Vilariño-Feltrer
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
| | | | - Vicente Lorenzo-Zúñiga
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Vicente Pons
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Pedro López-Muñoz
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Isabel Tort-Ausina
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
- CIBER-BBN,
ISCIII, 46022 València, Spain
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15
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Dargent J. Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project. Sci Rep 2024; 14:1252. [PMID: 38218989 PMCID: PMC10787753 DOI: 10.1038/s41598-024-51441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021-March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.
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Affiliation(s)
- Jerome Dargent
- Polyclinique de Rillieux, 65 Rue des Contamines, 69140, Rillieux-la-Pape, France.
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16
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Ang TL. Asian Pacific perspectives on the practice of green endoscopy. J Gastroenterol Hepatol 2024; 39:5-6. [PMID: 37940201 DOI: 10.1111/jgh.16405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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17
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Pohl H, Baddeley R, Hayee B. Carbon footprint of gastroenterology practice. Gut 2023; 72:2210-2213. [PMID: 37977578 DOI: 10.1136/gutjnl-2023-331230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Heiko Pohl
- Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Robin Baddeley
- Wolfson Unit for Endoscopy, St Mark's the National Bowel Hospital and Academic Institute, London, UK
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
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18
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Shiha MG, Nandi N, Hutchinson AJ, Raju SA, Tai FWD, Elli L, Penny HA, Sanders DS. Cost-benefits and environmental impact of the no-biopsy approach for the diagnosis of coeliac disease in adults. Frontline Gastroenterol 2023; 15:95-98. [PMID: 38420132 PMCID: PMC10897647 DOI: 10.1136/flgastro-2023-102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/04/2023] [Indexed: 03/02/2024] Open
Abstract
Objective Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice. Design We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy. Results Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over £2.5 million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO2 per year, equivalent to greenhouse gas emissions from driving 222 875 miles, carbon emissions from charging over 10 million smartphones and the carbon sequestrated by 1438 trees grown for 10 years. Conclusion The implementation of this non-invasive green approach could be an essential first step in the 'Reduce' strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.
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Affiliation(s)
- Mohamed G Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Nicoletta Nandi
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milano, Italy
| | - Andrew J Hutchinson
- Department of Electronic and Electrical Engineering, The University of Sheffield, Sheffield, UK
| | - Suneil A Raju
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Foong Way David Tai
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Hugo A Penny
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - David Surendran Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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Rodríguez de Santiago E. 28 kg of carbon dioxide per endoscopic procedure. Time to make green endoscopy a professional priority. Endoscopy 2023; 55:927-928. [PMID: 37500071 DOI: 10.1055/a-2120-4444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Enrique Rodríguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
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