Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature.

Background and Aims: Greenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO 2 ), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity.

Design: The GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded.

Results: Our search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions.

Conclusions: Recognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.

Competing Interests: Competing interests: AP, MJB, IP, AR, DNR, HT, DKR, CH: none. MD: Grant support: Intercept Pharma. PS: Consultant-Bausch, Boston Scientific Corporation, CDx Labs, Covidien LP, Exact Sciences, Fujifilm Medical Systems USA, Inc, Lucid, Lumendi, Medtronic, Phathom, Olympus, Takeda, Samsung BioepisGrant/Contract-Cosmo Pharmaceuticals, Covidien, Docbot, ERBE USA, Inc, Fujifilm Holdings America Corporation, Ironwood Pharmaceuticals, Inc., Medtronic USA, Inc.

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