Ripple Effect: Safety, Cost, and Environmental Concerns of Using Sterile Water in Endoscopy.
Deepak Agrawal1, Seth Crockett2, Sonali Palchaudhuri3
1Division of Gastroenterology, Dell Medical School, Dell Seton Medical Center, University Texas at Austin, Austin, Texas.
Gastro Hep Advances
|April 29, 2025
Summary
Tap water is a safe and cost-effective alternative for endoscopy lens cleaning and colon irrigation, reducing healthcare waste and environmental impact. Re-evaluating guidelines for sterile water use in endoscopy is recommended.
Area of Science:
- Gastroenterology
- Environmental Science
- Healthcare Waste Management
Background:
- Gastroenterology societies aim to reduce endoscopy's carbon footprint by reviewing waste-generating practices.
- The use of sterile water for lens cleaning and colon irrigation is a common practice under scrutiny.
- Current guidelines for sterile water in endoscopy lack robust evidence and rely heavily on expert opinion.
Purpose of the Study:
- To critically review the medical literature and guidelines regarding the safety and necessity of sterile water in endoscopy.
- To assess the environmental impact, specifically the carbon footprint, of using sterile water in endoscopic procedures.
- To evaluate tap water as a safe, cost-effective, and environmentally friendly alternative.
Main Methods:
- Comprehensive review of published medical literature and existing guidelines on water use in endoscopy.
- Calculation of the cradle-to-grave carbon footprint for sterile water bottles.
- Comparison of sterile water's environmental impact with bottled drinking water and assessment of clinical evidence.
Main Results:
- Guidelines recommending sterile water are based on limited evidence and expert opinions, with referenced protocols often not implemented.
- Two clinical studies demonstrated tap water as a safe, practical, and cost-saving alternative in gastrointestinal endoscopy.
- Bottled sterile water has a significant carbon footprint (575 g CO2 equivalent per liter), contributing to healthcare waste and climate change.
Conclusions:
- There is a lack of direct evidence supporting the widespread recommendation and use of sterile water in gastrointestinal endoscopy.
- Switching to tap water for filling sterile water bottles can reduce environmental harm and costs associated with endoscopy.
- Guidelines should be re-evaluated to incorporate environmental and societal impact, prioritizing patient care without unnecessary risks or waste.
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