Nursing leadership for sustainable endoscopy: a narrative review and practice framework

Gastrointestinal endoscopy is a resource-intensive clinical service that generates substantial waste, consumes water and energy, and depends on disposable accessories, sterile packaging, and complex reprocessing pathways. Although green endoscopy has received increasing attention, current sustainability strategies have often emphasized physician decision-making, technological innovation, or industry-level redesign, while the practical contribution of endoscopy nurses remains insufficiently defined. This narrative review developed a nursing-centred framework for sustainable endoscopy practice, focusing on how nurses can translate green endoscopy policy into routine clinical action. Literature searches of PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar were updated through 31 August 2026; CINAHL was subsequently searched on 4 September 2026, and professional-society statements and reference lists were hand-searched. The CINAHL search retrieved 403 records, with no unique additional records remaining after deduplication against the existing search set. Environmental evidence was classified as directly measured physical or resource outcomes, calculated or modelled carbon-footprint outcomes (including life-cycle assessment), or inferred downstream implications from clinical or operational findings. The evidence varied in study design, clinical setting, sustainability focus, and reported outcomes, and was synthesized thematically across the endoscopy pathway. Key domains included nursing-led waste segregation, consumable stewardship, cleaning and reprocessing support, patient preparation, and sustainability education, together with nursing-supported multidisciplinary decisions on device selection, procedure scheduling, and green procurement. Available evidence suggests that nursing-led interventions, including structured waste segregation, staff education, audit, careful management of consumables, and reprocessing stewardship, can reduce avoidable waste and, where carbon accounting was performed, associated calculated or modelled emissions and waste-processing costs while maintaining patient safety and procedural efficiency. However, nursing-specific intervention studies and standardized sustainability indicators remain limited, and much of the evidence originates from high-resource settings. A designated Green Endoscopy Nurse or sustainability-lead function may provide a useful implementation model for embedding environmental responsibility into everyday endoscopy nursing practice, although current evidence does not yet establish this role as a universal staffing standard.