Is There an Environmental Impact From Inappropriate Endoscopy?

Is There an Environmental Impact From Inappropriate Endoscopy?

Vanessa M. Shami, MD, FASGE, reviewing Elli L, et al. Gastrointest Endosc 2023 Sep 4.

Endoscopy plays a significant role in a gastroenterologist’s practice. Unindicated or inappropriate endoscopies increase costs, take away resources from other patients, and may have a negative environmental impact by polluting. This study aimed to estimate the carbon footprint of inappropriate digestive endoscopy.

The investigators searched Pubmed and national registries to estimate the number of inappropriate endoscopies performed in Italy and calculated the carbon costs of esophagogastroduodenoscopy (EGD) and colonoscopy. This included disposable materials, personal protective equipment, the energy required for the endoscopy procedure, and the cleaning process. They also calculated the rates of inappropriateness and the mortality cost of carbon of endoscopic examinations in different scenarios. 

Colonoscopy and EGD were estimated to emit 6.71 kg and 5.43 kg of carbon dioxide (CO2), respectively. The authors assessed varying scenarios based on the number of endoscopic procedures performed in Italy per 1000 inhabitants and data on their inappropriateness. They determined that, every year, the total carbon footprint of unnecessary endoscopies in Italy was 4133 CO2 metric tons, ranging from 3527 to 4749 CO2 metric tons. This is equivalent to 1.76 million liters of gasoline per year. When they extrapolated the data to the European population, the estimated carbon footprint of unindicated endoscopy in Europe was 30,804 metric tons.

Vanessa M. Shami, MD, FASGE


In a profession that performs endoscopy as the mainstay of practice, the appropriateness of procedures should always be evaluated. Unfortunately, factors such as patients‘ and referring physicians‘ expectations and the concern of missed diagnoses drive up this practice. This manuscript highlights the significant environmental cost of inappropriate endoscopies. With the increased use of disposable items, environmental costs will surely rise.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Elli L, La Mura S, Rimondi A, et al. The carbon cost of inappropriate endoscopy. Gastrointest Endosc 2023 Sep 4. (Epub ahead of print) (

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