Rationalising the use of specimen pots following colorectal polypectomy: a small step towards greener endoscopy

Can Gastric Juice Analysis with EndoFaster® Reduce the Environmental Impact of Upper Endoscopy?

Gastrointestinal (GI) endoscopy services are in third place as major contributors to CO2 emissions among healthcare facilities, especially due to their massive waste production. One of the measures suggested to reduce this environmental impact is a reduction in histological examinations performed on biopsy specimens taken during endoscopy. A reliable candidate to reduce the rate of biopsies and, consequently, the impact of CO2 emissions could be EndoFaster®, an innovative medical device that allows one to suspect or rule out both H. pylori infection and precancerous lesions on the gastric mucosa by analyzing a small amount of gastric juice aspirated during endoscopy in real time. In the present study, we investigated the ability of EndoFaster® to reduce the environmental impact of upper endoscopy, comparing the CO2 production of standard biopsy sampling as suggested in guidelines and biopsies guided by real-time EndoFaster® results during endoscopy. By estimating an overall 90% rate of biopsies according to standard guidelines and a reduction of 50% of gastric biopsies based on EndoFaster® results, we calculated a 44% overall reduction in CO2 emissions, demonstrating that by using this tool, it is possible to distinctly reduce the contribution of upper endoscopy to global warming.

Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps

Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses on areas that can reduce the carbon footprint of service provision in gastroenterology and hepatology. In this manuscript, we performed a scoping review to understand the current evidence base of the impact of gastroenterology and hepatology services on the environment as well as exploring any association between pollution and climate change with gastrointestinal and liver disease. We further discuss the barriers that researchers face in delivering environmentally sustainable research, the limitation in clinical guidelines related to practicing environmentally sustainable gastroenterology and hepatology and how the trainee research networks are ideally placed to initiate change by developing, disseminating and implementing best practice in ‘green Gastroenterology’.