P277 The environmental impact of wasteful procedures in two UK endoscopy units

Introduction

The NHS is the first healthcare system to commit to carbon neutrality by 2045. There is increasing recognition that endoscopies make a significant contribution to the NHS carbon footprint, which must be assessed to develop a greener service. This study aims to identify the proportion of procedures and biopsies that could have been avoided, to inform changes that will increase sustainability.

Methods

All procedures over 7 days in October 2021 within 2 endoscopy units were included. Relevant data - indication, referrer, biomarkers, blood tests, biopsies, and outcome - were collected for each case, and reviewed by two independent senior gastroenterologists to identify avoidable procedures and sampling. The carbon footprint of wasteful procedures was calculated using published data^{1 2} and a publicly available calculator based on patient journey miles.³

Results

235 cases were analysed (gastroscopy 44%, flexible sigmoidoscopy 15%, colonoscopy 41%). Referrals were made by gastroenterology 23%, surgery 51%, medicine 8%, GP 14%, and specialist nurse 2-week-wait 4%. 43 (18%) procedures were deemed avoidable, of which 53% were colonoscopy, 42% gastroscopy, 5% flexible sigmoidoscopy. These referrals came from: surgery (63%), gastroenterology (19%), GP (9%) and medicine (7%). Common reasons for colonoscopies being inappropriate were incomplete biomarkers (35%), flexible sigmoidoscopy being more appropriate (30%), and non-iron deficient anaemia (IDA, 17%); for gastroscopies, low risk abdominal pain <55 years (60%) and non-IDA (40%). 82% of biopsies sent from colonoscopies were indicated compared to only 49% from gastroscopy (figure 1). The estimated carbon footprint of wasteful procedures (including patient journeys, endoscopy, waste generation, and biopsy processing), was 233 kgCO2e/week; approximately 12 tCO2e/year (117 return economy flights from London to Paris³).

Conclusion

Avoidable endoscopies have a detrimental environmental impact. Rigorous vetting, and education on appropriate sampling in gastroscopy, will help mitigate this. 1. Siau, K., Hayee, B. H. & Gayam, S. Endoscopy’s Current Carbon Footprint. Tech. Innov. Gastrointest. Endosc. 23, 344–352 (2021). 2. Gordon, I. O., Sherman, J. D., Leapman, M., Overcash, M. & Thiel, C. L. Life Cycle Greenhouse Gas Emissions of Gastrointestinal Biopsies in a Surgical Pathology Laboratory. Am. J. Clin. Pathol. 156, 540–549 (2021). 3. Carbon Footprint Calculator. Available at: https://calculator.carbonfootprint.com/calculator.aspx?tab=4. (Accessed: 14th February 2022)