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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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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. Gastroenterology 2024; 166:496-502.e3. [PMID: 38123023 DOI: 10.1053/j.gastro.2023.12.006] [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: 08/29/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND & AIMS Gastrointestinal (GI) endoscopy procedures are critical for screening, diagnosis, and treatment of a variety of GI disorders. However, like the procedures in other medical disciplines, they are a source of environmental waste generation and energy consumption. METHODS We 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. We used an endoscopy staff-guided auditing and review of the items used during procedures to determine potentially recyclable items going to landfill waste. The waste generated was stratified into biohazardous, nonbiohazardous, 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 kW·h 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 GI 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/d) that could be avoided by appropriate waste segregation of these items. CONCLUSIONS On average, every 100 GI endoscopy procedures (esophagogastroduodenoscopy/colonoscopy) are associated with 303 kg of solid waste and 1385 gallons of liquid waste generation, and 1980 kW·h 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.
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Carlissa Campbell
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Abhilash Perisetti
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Sachin Srinivasan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Dhruvil Radadiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Harsh Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Stephanie Melquist
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas.
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Tavabie O, Clough J, King J, Nicholas V, Kumar A. Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps. Frontline Gastroenterol 2023:flgastro-2023-102497. [DOI: 10.1136/flgastro-2023-102497] [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: 12/16/2023] Open
Abstract
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’.
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Perisetti A, Desai M, Bourke MJ, Penman I, Repici A, Reddy DN, Tajiri H, Rex DK, Hassan C, Sharma P. Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature. Gut 2023; 72:493-500. [PMID: 36522150 DOI: 10.1136/gutjnl-2022-328369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/29/2022] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Abhilash Perisetti
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Madhav Desai
- Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ian Penman
- Gastroenterology and Hepatology, Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Alessandro Repici
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Duvvur Nageshwar Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Hisao Tajiri
- Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Douglas K Rex
- Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Cesare Hassan
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Missouri, USA
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Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, Coulter A, Disney BR, Griffiths H, Healey C, Hillson R, Steinbach I, Marshall S, Rajendran A, Rochford A, Thomas-Gibson S, Siddhi S, Stableforth W, Wesley E, Brett B, Morris AJ, Douds A, Coleman MG, Veitch AM, Hayee B. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72:12-26. [PMID: 36229172 PMCID: PMC9763195 DOI: 10.1136/gutjnl-2022-328460] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/08/2022]
Abstract
GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.
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Affiliation(s)
- Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, East Riding of Yorkshire, UK .,Clinical Sciences Centre, Hull York Medical School, Hull, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Robin Baddeley
- Institute for Therapeutic Endoscopy, King's College Hospital, London, UK,Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Leigh Donnelly
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosemary Haddock
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ramesh Arasaradnam
- Applied Biological and Experimental Sciences, Coventry University, Coventry, UK,Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Archibald Coulter
- Department of Gastroenterology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Benjamin Robert Disney
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Helen Griffiths
- Department of Gastroenterology, Brecon War Memorial Hospital, Brecon, UK
| | - Christopher Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Sarah Marshall
- Bowel Cancer Screening & Endoscopy, London North West University Healthcare NHS Trust, Harrow, UK,Joint Advisory Group on GI Endoscopy, London, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Andrew Rochford
- Department of Gastroenterology, Royal Free Hospitals, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Sandeep Siddhi
- Department of Gastroenterology, NHS Grampian, Aberdeen, UK
| | - William Stableforth
- Departments of Gastroenterology & Endoscopy, Royal Cornwall Hospital, Truro, UK
| | - Emma Wesley
- Departments of Gastroenterology & Endoscopy, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Bernard Brett
- Department of Gastroenterology, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | | | - Andrew Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Mark Giles Coleman
- Joint Advisory Group on GI Endoscopy, London, UK,Department of Colorectal Surgery, Plymouth University Hospitals Trust, Plymouth, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, 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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Clough J, Donnelly L, Leddin D, Hayee B. FGTwitter debate: green gastroenterology - are we nearly there yet? Frontline Gastroenterol 2022; 14:158-161. [PMID: 36818799 PMCID: PMC9933594 DOI: 10.1136/flgastro-2022-102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Jennie Clough
- Gastroenterology, Guys and St Thomas NHS Trust, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Leigh Donnelly
- Endoscopy, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Desmond Leddin
- Department of Medicine, Dalhousie University, Halifax, New Brunswick, Canada
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
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Donnelly L. Green endoscopy: practical implementation. Frontline Gastroenterol 2022; 13:e7-e12. [PMID: 35812035 PMCID: PMC9234726 DOI: 10.1136/flgastro-2022-102116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
There is a necessity for endoscopy services as a speciality to lead the way in creating more sustainable departments. It is important we seek to explore and implement practical measures to ensure endoscopy services are working to meet our sustainability goals. The following article explores the practical implementation of measures which can be taken to make endoscopy greener.
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Affiliation(s)
- Leigh Donnelly
- Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Veitch AM. Greener gastroenterology and hepatology: the British Society of Gastroenterology Strategy for Climate Change and Sustainability. Frontline Gastroenterol 2022; 13:e3-e6. [PMID: 35812022 PMCID: PMC9234742 DOI: 10.1136/flgastro-2022-102134] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
There is a global climate emergency, and also a global health concern related to climate change. The British Society of Gastroenterology (BSG) acknowledges these issues, and supports the concerns of its members to address them. Climate change has adverse effects on gastroenterological and liver disease, and on healthcare systems. The healthcare industry, itself, is also a major contributor to greenhouse gases. BSG has developed a strategy on Climate Change and Sustainability, which encompasses all of the activities of the society, and its members: personal, professional, organisational, political, international and research.
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Affiliation(s)
- Andrew M Veitch
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Colwill M, Lake L, El-Sayed A, King J, Kader R, Shakweh E, Caracostea A, China L, Maurice J. Unlocking the benefits of the Baveno VI guidance when screening for varices: an audit of clinical practice across London. Future Healthc J 2022; 9:41-44. [PMID: 35372760 PMCID: PMC8966789 DOI: 10.7861/fhj.2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background The Baveno VI consensus identifies patients with compensated advanced chronic liver disease (cACLD) who can safely avoid screening endoscopy. However, concordance in clinical practice with this guidance is unknown. We audited clinical practice and the provision of transient elastography (TE) aiming to identify potential cost savings and benefits. Methods Retrospective data collection from 12 sites across London over 6 months by reviewing oesophagogastroduodenoscopy (OGD) reports, platelet count and TE results as well as information on site-specific provision of TE. Results Three-hundred and fifty-one screening procedures were identified; 177 (50.43%) had a TE test performed within the preceding 12 months; 142 (80.23%) patients with a recent TE test did not meet criteria for screening OGD. TE provision varied widely between sites. Conclusion Improving concordance with the Baveno criteria through improved provision of TE would have benefits for patients, healthcare systems and the environment and would help to address the challenges of moving on from the COVID-19 pandemic.
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Affiliation(s)
- Michael Colwill
- Epsom and St Helier University Hospitals NHS Trust, London, UK
| | | | - Ahmed El-Sayed
- London North West University Healthcare NHS Trust, London, UK
| | | | | | | | | | - Louise China
- Royal Free London NHS Foundation Trust, London, UK
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Tavabie OD, Clough J, Kumar A. Gastroenterology 2022: Groundhog Day. Frontline Gastroenterol 2022; 13:349-351. [PMID: 35722604 PMCID: PMC9186062 DOI: 10.1136/flgastro-2022-102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Jennie Clough
- Gastroenterology Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Aditi Kumar
- Gastroenterology Department, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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