Interventional endoscopy procedures produce about twice the greenhouse gas emissions per case as standard gastrointestinal procedures, even though they make up a smaller portion of daily cases in a tertiary care unit. The finding comes from a life cycle assessment (LCA) at a single academic medical center.
“Gastroenterology is a resource-intensive medical specialty, and endoscopy is the third-highest waste generating specialty in healthcare,” Frances Dang, MD, MSc, a gastroenterologist at the University of California, Irvine Medical Center (UCI) said during an abstract presentation at Digestive Disease Week® (DDW) 2026. “Previous studies and prior audits have quantified the environmental impact of diagnostic procedures. However, environmental assessments of interventional endoscopy remain limited.”
In a process-based LCA, she and her colleagues measured the environmental impact of all procedures performed in a tertiary endoscopy suite at UCI over three audit days. They incorporated material use, energy consumption from heating, ventilating, and air conditioning systems, and patient travel distances, and quantified environmental harm as global warming potential (in kilograms of carbon dioxide equivalents) to better identify and target opportunities for reduction.
During the study period, researchers documented 128 items from the endoscopy unit and performed 137 procedures. Of these, 106 (77%) were general GI procedures such as upper endoscopy and colonoscopy, averaging 35.3 per day, while 31 (23%) were interventional procedures, including endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, averaging 10.3 per day. Patients traveled an average of 61 kilometers to the facility.
Total daily emissions from the endoscopy unit amounted to 6,250 kilograms of carbon dioxide equivalents. General procedures accounted for 3,950 kilograms per day, or about 112 kilograms per procedure. Interventional procedures contributed 2,299 kilograms per day, or about 222 kilograms per procedure — about double the per-case emissions of general procedures.
In their audit of water, Dr. Dang and colleagues estimated that a general GI procedure produces about 2.02 kilograms of waste on average, adding up to 72.79 kilograms per day. An interventional procedure produces about 3.47 kilograms on average, or 34.75 kilograms per day.
The four largest contributors to environmental burden across both procedure types were energy, water, processing chemicals, and gowns/bedding/linens. Interventional procedures had higher emissions per case mostly due to equipment reprocessing requirements, particularly for endoscopic ultrasound scopes.
“From the manufacturers of our endoscope reprocessors, we found that each cycle uses approximately 77.3 liters, or about 21 gallons, of water,” Dr. Dang said. “As you can imagine, in a busy endoscopy suite, this adds up to a substantial amount of water used each day. This is one of the key reasons why water consumption ranks so high in terms of environmental impact within our operations.”
She and her colleagues are pursuing strategies to reduce waste and improve sustainability within their unit, including implementing proper waste segregation practices, as there is currently no recycling or structured separation of waste streams in place. They are also prioritizing staff education and feedback to reinforce sustainable practices in daily workflows, including reprocessing two endoscopes simultaneously rather than separately.
In collaboration with facilities management, they are evaluating opportunities to optimize HVAC usage and considering the feasibility of installing solar panels on the facility’s roof to better harness and utilize this source.
“The HVAC in our endoscopy unit building is on for pretty much 24/7,” Dr. Dang said. “Being able to control or turn off portions of the building when not in use will be helpful.”
The findings provide a detailed snapshot of environmental drivers within a high-volume endoscopy unit and identify modifiable factors that could reduce emissions.
“As climate change continues to reshape our healthcare systems, conscientious materials purchasing, optimized recycling and processing, and continual endoscopy suite audits can mitigate overall waste and reduce environmental impact,” the investigators wrote in their abstract.
Dr. Dang disclosed that she is a consultant and/or speaker for Cook Medical, Applied Medical, Fujifilm, and Micro-Tech.
DDW is AGA’s annual meeting, jointly sponsored by AGA, AASLD, ASGE, and SSAT. Learn more at ddw.org.