Endoscopy 2024; 56(05): 355-363
DOI: 10.1055/a-2240-9414
Original article

Perspectives and awareness of endoscopy healthcare professionals on sustainable practices in gastrointestinal endoscopy: results of the LEAFGREEN survey

1   Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
2   Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, IRYCIS, Madrid, Spain
3   Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
Heiko Pohl
4   Section of Gastroenterology, Dartmouth College Geisel School of Medicine, Hanover, United States (Ringgold ID: RIN12285)
5   Section of Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, United States (Ringgold ID: RIN20127)
6   Department of Gastroenterology and Endoscopy unit IIS La Fe, Hospital Universitari i Politecnic La Fe, Valencia, Spain (Ringgold ID: RIN16273)
Miguel F. Cunha
7   Colorectal Disease Group – Department of General Surgery, Algarve University Hospital Centre, Portimão, Portugal
8   Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucuresti, Romania
9   Carol Davila University of Medicine and Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania (Ringgold ID: RIN87267)
10   Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
Douglas G. Penman
11   Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4595)
12   Endoscopy and Gastroenterology, Hospital Universitario de Navarra (HUN), Pamplona, Spain
13   Gastroenterology, Navarrabiomed; Universidad Pública de Navarra (UPNA); IdiSNA, Pamplona, Spain
14   Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8028)
Leigh Donnelly
15   Endoscopy Department, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN6072)
16   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
Mathieu Pioche
17   Endoscopy Unit, Hospices Civils de Lyon, Lyon, France (Ringgold ID: RIN26900)
Ulrike Beilenhoff
18   Endoscopy, ESGENA Scientific Secretariat, Ferdinand- Sauerbruch-Weg 16, 89075 Ulm, Germany
Marianna Arvanitakis
19   Gastroenterology, Erasme University Hospital, Brussels, Belgium
Bas L.A.M. Weusten
20   Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
21   Department of Gastroenterology & Hepatology, Utrecht University, Utrecht, Netherlands (Ringgold ID: RIN8125)
22   Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
Cesare Hassan
23   Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)
24   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
Helmut Messmann
10   Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
Ian M. Gralnek
25   Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel (Ringgold ID: RIN61172)
26   Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel (Ringgold ID: RIN58880)
Mário Dinis-Ribeiro
27   Gastroenterology, Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
28   Gastroenterology, RISE@CI-IPOP (Health Research Network), Porto, Portugal
› Author Affiliations


Background Gastrointestinal (GI) endoscopy is one of healthcare’s main contributors to climate change. We aimed to assess healthcare professionals’ attitudes and the perceived barriers to implementation of sustainable GI endoscopy.

Methods The LEAFGREEN web-based survey was a cross-sectional study conducted by the European Society of Gastrointestinal Endoscopy (ESGE) Green Endoscopy Working Group. The questionnaire comprised 39 questions divided into five sections (respondent demographics; climate change and sustainability beliefs; waste and resource management; single-use endoscopes and accessories; education and research). The survey was available via email to all active members of the ESGE and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) in March 2023.

Results 407 respondents participated in the survey (11% response rate). Most participants (86%) agreed climate change is real and anthropogenic, but one-third did not consider GI endoscopy to be a significant contributor to climate change. Improvement in the appropriateness of endoscopic procedures (41%) and reduction in single-use accessories (34%) were considered the most important strategies to reduce the environmental impact of GI endoscopy. Respondents deemed lack of institutional support and knowledge from staff to be the main barriers to sustainable endoscopy. Strategies to reduce unnecessary GI endoscopic procedures and comparative studies of single-use versus reusable accessories were identified as research priorities.

Conclusions In this survey, ESGE and ESGENA members acknowledge climate change as a major threat to humanity. Further improvement in sustainability beliefs and professional attitudes, reduction in inappropriate GI endoscopy, and rational use of single-use accessories and endoscopes are critically required.

Supplementary Material

Publication History

Received: 19 July 2023

Accepted after revision: 07 December 2023

Article published online:
26 January 2024

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