Impact of Teleconsultation before Endoscopic Submucosal Dissection on Quality of Care and Environmental...

Introduction The European Society of Gastrointestinal Endoscopy has highlighted the environmental impact of endoscopic practice and the need to reduce it. One of the major contributors is patient transportation, despite the availability of remote alternatives for preprocedural consultations. The aim of this study was to compare face-to-face (FF) and virtual remote (VR) consultations prior to colorectal endoscopic submucosal dissection (ESD) in terms of effectiveness, safety, and carbon footprint. Methods We used a prospective national database including consecutive colorectal ESD cases performed in France between July 2023 and September 2024. Preprocedural consultations were conducted either FF or via VR consultation, according to patient preference and logistical feasibility. Procedure-related travel included diagnostic colonoscopy and/or local consultation, anesthesiology consultation (local or remote, excluding same-day combined visits), gastroenterology consultation at the referral center, and travel for the ESD procedure itself. Environmental impact was estimated based on the distance between the patient's residence and the endoscopy unit, the mode of transportation, and validated conversion coefficients. Results Between July 2023 and September 2024, 1729 patients undergoing colorectal ESD were included; 1451 (84%) underwent face-to-face (FF) and 278 (16%) virtual remote (VR) preprocedural consultations. Baseline characteristics were comparable. En bloc, R0, and curative resection rates were similar between FF and VR groups (97% vs 95%, p = 0.31; 92% vs 88%, p = 0.13; 90% vs 90%, p = 0.86), as were bleeding and perforation rates. The median cumulative travel distance was significantly lower in the VR group (180.0 km [IQR 261.0] vs 394.6 km [IQR 447.6], p < 0.001). Median cumulative carbon footprint decreased from 89.4 to 31.9 CO₂-eq units ( p < 0.001), corresponding to a total saving of 51,106 CO₂-eq units. Conclusion Colorectal ESD performed after VR consultation shows comparable effectiveness and safety to FF consultation, while significantly reducing the carbon footprint.