Why should we care about green endoscopy?

This is a question I often get asked by patients, medical and nursing colleagues, and students. Many of them know about my passion for making endoscopy more sustainable, so I enjoy discussing this question with them. In a recent event hosted by PENTAX Medical, we speak about the coordinated and sustained efforts that are needed to address climate change, especially in the healthcare sector, and why green endoscopy is the future.

A fact that often finds its way into these conversations is the following: health care accounts for 4.4% of the global carbon footprint. In some countries, this is as high as 8.5% (Sherman et al., 2020). This highlights the fact that we must think about the environment when considering the cost of healthcare – not just the cost in the traditional, economic way. 80% of our industry’s carbon emissions are attributable to clinical decisions, so everyone, including physicians, must play their part.

Harvesting low-hanging fruits

Given the high number of cases and many non-renewable waste streams, endoscopic departments are the third most waste-generating departments in a hospital setting. Only anesthetics and intensive care come before it (Vaccari et al., 2018; Siau et al., 2022). One singular endoscopy produces 2.4 kilograms of waste and 64% of this goes to landfills. We have a duty and we must change this.

Fortunately, there are many ‘low-hanging fruits’ that can minimize the environmental footprint of endoscopic departments. One of the most important aspects is reducing unnecessary procedures – the biggest waste in endoscopy is the procedure that was not needed. We should have better vetting procedures to determine the appropriateness of endoscopy and where possible use other non-invasive modalities. Or take biopsies, where sample cells are extracted for medical examination, and a lot of innovating has been done. One US study analyzed whether biopsy pots could be reduced or whether their size could be reduced, and found statistical improvement (Gordon & Am, 2021). As practitioners, we must consider how we can implement such findings across our endoscopy units.

Moving forward as one

The endoscopic field must also harvest the fruits that are higher up in the tree, and be mindful of the entire supply chain. We need to hold each other accountable for the procurement, packaging, delivery, and use of our products, and innovate wherever possible. There are lessons that we can learn from other fields, for example, consumer plastics. A cultural change meant that we are now using reusable bags for our shopping. We are seeing a similar transformation in our field – a cultural change is happening as endoscopic units are transforming themselves into dream green endoscopy teams and the industry is starting to listen. Companies, such as PENTAX Medical, have sustainability high on their agenda and are looking to minimize the environmental impact of their solutions.

The true elephant in the room is that we need to have a proper and informed debate on single-use devices. On top of this, sustainable solutions in the reprocessing cycle need to be created that marry sustainability and hygiene. Ultimately endoscopy needs to reinvent itself. We simply cannot go back to business as usual; we need to be part of the solution, not the problem. The key is for practitioners and industry to work together, find solutions, and collaborate on this journey for environmental sustainability. Pictures of our beautiful planet must be kept in mind during these discussions, and together we must act in the long-term interest of our children and future generations. This is why we should care about green endoscopy.


I recently joined forces with other physicians to further develop green endoscopy units in the UK. Watch my recent panel at the Hygiene Event to learn more.