Carbon Footprint of Routine Endoscopic Procedures: A Comprehensive Assessment in Three United States Endoscopy Units

Health care is a major contributor to greenhouse gas emissions; however, data on the carbon footprint of performing endoscopic procedures are limited. We aimed to quantify the emissions generated by performing a routine endoscopic procedure.

We conducted a prospective 1-week audit of endoscopic procedures at 3 United States endoscopy units that included pre- and post-procedural care; sedation; patient travel; reprocessing; heating, ventilation, and air conditioning; and energy needs. A life cycle assessment was applied to quantify the carbon footprint of performing a routine endoscopic procedure, expressed as kgCO₂e. We further examined the contribution of emission sources and compared colonoscopy and upper endoscopy emissions.

A total of 133 routine endoscopies were audited. Fifty-nine percent were performed with monitored anesthesia care, and 82% involved ancillary instruments (snare, forceps, or hemoclip). The mean carbon footprint of a routine endoscopy was 53.2 kgCO₂e, with similar emissions for colonoscopy and esophagogastroduodenoscopy (55.2 and 51.5 kgCO₂e, respectively). Performing esophagogastroduodenoscopy and colonoscopy for the same patient on the same day reduces the combined carbon footprint by 42%. Heating, ventilation, and air conditioning and electricity together accounted for 42% of emissions, patient travel for 29%, supplies for 22%, and reprocessing for 4%. Emissions varied substantially across endoscopy units, ranging from 44.9 to 68.7 kgCO₂e, a 1.5-fold difference.

This comprehensive carbon footprint analysis demonstrated comparable emissions across routine endoscopic procedures, but notable variation between endoscopy units. Heating, ventilation, and air conditioning and energy use were the largest contributors to total emissions, suggesting that site-specific reductions may yield the greatest potential for carbon savings in routine endoscopy.