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

João A. Cunha Neves; Enrique Rodriguez de Santiago; Heiko Pohl; Vicente Lorenzo-Zúñiga; Miguel F. Cunha; Andrei M. Voiosu; Christoph Römmele; Douglas G. Penman; Eduardo Albéniz; Keith Siau; Leigh Donnelly; Luca Elli; Mathieu Pioche; Ulrike Beilenhoff; Marianna Arvanitakis; Bas L.A.M. Weusten; Raf Bisschops; Cesare Hassan; Helmut Messmann; Ian M. Gralnek; Mário Dinis-Ribeiro

doi:10.1055/a-2240-9414

Endoscopy, Table of Contents

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

João A. Cunha Neves ‡

¹Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal

,

Enrique Rodriguez de Santiago ‡

²Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, IRYCIS, Madrid, Spain

³Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

,

Heiko Pohl

⁴Section of Gastroenterology, Dartmouth College Geisel School of Medicine, Hanover, United States (Ringgold ID: RIN12285)

⁵Section of Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, United States (Ringgold ID: RIN20127)

,

Vicente Lorenzo-Zúñiga

⁶Department of Gastroenterology and Endoscopy unit IIS La Fe, Hospital Universitari i Politecnic La Fe, Valencia, Spain (Ringgold ID: RIN16273)

,

Miguel F. Cunha

⁷Colorectal Disease Group – Department of General Surgery, Algarve University Hospital Centre, Portimão, Portugal

,

Andrei M. Voiosu

⁸Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucuresti, Romania

⁹Carol Davila University of Medicine and Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania (Ringgold ID: RIN87267)

,

Christoph Römmele

¹⁰Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)

,

Douglas G. Penman

¹¹Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4595)

,

Eduardo Albéniz

¹²Endoscopy and Gastroenterology, Hospital Universitario de Navarra (HUN), Pamplona, Spain

¹³Gastroenterology, Navarrabiomed; Universidad Pública de Navarra (UPNA); IdiSNA, Pamplona, Spain

,

Keith Siau

¹⁴Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8028)

,

Leigh Donnelly

¹⁵Endoscopy Department, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN6072)

,

Luca Elli

¹⁶Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)

,

Mathieu Pioche

¹⁷Endoscopy Unit, Hospices Civils de Lyon, Lyon, France (Ringgold ID: RIN26900)

,

Ulrike Beilenhoff

¹⁸Endoscopy, ESGENA Scientific Secretariat, Ferdinand- Sauerbruch-Weg 16, 89075 Ulm, Germany

,

Marianna Arvanitakis

¹⁹Gastroenterology, Erasme University Hospital, Brussels, Belgium

,

Bas L.A.M. Weusten

²⁰Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands

²¹Department of Gastroenterology & Hepatology, Utrecht University, Utrecht, Netherlands (Ringgold ID: RIN8125)

,

Raf Bisschops

²²Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium

,

Cesare Hassan

²³Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)

²⁴Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy

,

Helmut Messmann

¹⁰Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)

,

Ian M. Gralnek

²⁵Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel (Ringgold ID: RIN61172)

²⁶Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel (Ringgold ID: RIN58880)

,

Mário Dinis-Ribeiro

²⁷Gastroenterology, Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal

²⁸Gastroenterology, RISE@CI-IPOP (Health Research Network), Porto, Portugal

› Author Affiliations

Abstract

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.

Full Text

References

References
1 Siau K, Hayee BH, Gayam S. Endoscopy's current carbon footprint. Tech Innov Gastrointest Endosc 2021; 23: 344-352
2 Maurice JB, Siau K, Sebastian S. et al. Green endoscopy: a call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol 2020; 5: 636-638
3 Siddhi S, Dhar A, Sebastian S. Best practices in environmental advocacy and research in endoscopy. Tech Innov Gastrointest Endosc 2021; 23: 376-384
4 Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H. et al. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54: 797-826
5 Agrawal D, Shoup V, Montgomery A. et al. Disposal of endoscopic accessories after use: do we know and do we care?. Gastroenterol Nurs 2017; 40: 13-18
6 de Melo Jr SW, Taylor GL, Kao JY. Packaging and waste in the endoscopy suite. Tech Innov Gastrointest Endosc 2021; 23: 371-375
7 Cunha Neves JA, Roseira J, Queirós P. et al. Targeted intervention to achieve waste reduction in gastrointestinal endoscopy. Gut 2023; 72: 306-313
8 Leddin D, Omary MB, Metz G. et al. Climate change: a survey of global gastroenterology society leadership. Gut 2022; 71: 1929-1932
9 Sharma A, Minh Duc NT, Luu Lam Thang T. et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Int Med 2021; 36: 3179-3187
10 Lacroute J, Marcantoni J, Petitot S. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 5: 918-926
11 Health professionals call for Fossil Fuel Non-Proliferation Treaty to protect lives of current and future generations. Accessed December 19, 2023 at: https://fossilfueltreaty.org/health-letter
12 Masson-Delmotte V, Zhai P, Pirani A. et al. Intergovernmental Panel on Climate Change (IPCC), 2021: Summary for policymakers. In: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press; 2023: 3-32
13 Citizen support for climate action. Accessed December 19, 2023 at: https://climate.ec.europa.eu/citizens/citizen-support-climate-action_en#ref-2021-survey
14 Sarfaty M, Bloodhart B, Ewart G. et al. American Thoracic Society member survey on climate change and health. Ann Am Thorac Soc 2015; 12: 274-278
15 Bortoluzzi F, Sorge A, Vassallo R. et al. Sustainability in gastroenterology and digestive endoscopy: Position Paper from the Italian association of hospital gastroenterologists and digestive endoscopists (AIGO). Dig Liver Dis 2022; 54: 1623-1629
16 Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2023; 20: 399-410
17 Cunha Neves JA, Roseira J, Cunha MF. et al. Towards a greener endoscopy: Considerations on the strategies to improve sustainability. Dig Liver Dis 2023; 55: 429-430
18 Sebastian S, Dhar A, Baddeley R. et al. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72: 12-26
19 Sheffield KM, Han Y, Kuo YF. et al. Potentially inappropriate screening colonoscopy in Medicare patients: variation by physician and geographic region. JAMA Int Med 2013; 173: 542-550
20 de Jong JJ, Lantinga MA, Drenth JP. Prevention of overuse: A view on upper gastrointestinal endoscopy. World J Gastroenterol 2019; 25: 178-189
21 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022; 71: 1326-1331
22 Gayam S. Environmental impact of endoscopy: "scope" of the problem. Am J Gastroenterol 2020; 115: 1931-1932
23 Haddock R, Gopfert A, van Hove M. et al. The case for sustainable endoscopy as a professional priority. Tech Innov Gastrointest Endosc 2021; 23: 337-343
24 Arup and Health Care Without Harm. Healthcare’s climate footprint. Accessed April 15, 2023 at: https://www.arup.com/perspectives/publications/research/section/healthcares-climate-footprint
25 Calderwood AH, Chapman FJ, Cohen J. et al. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 2014; 79: 363-372
26 Rauwers AW, Voor In 't Holt AF, Buijs JG. et al. High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study. Gut 2018; 67: 1637-1645
27 US Food and Drug Administration. The FDA continues to remind facilities of the importance of following duodenoscope reprocessing instructions: FDA safety communication. 2019 Accessed December 19, 2023 at: https://wayback.archive-it.org/7993/20201222112113/https:/www.fda.gov/medical-devices/safety-communications/fda-continues-remind-facilities-importance-following-duodenoscope-reprocessing-instructions-fda
28 Le NNT, Hernandez LV, Vakil N. et al. Environmental and health outcomes of single-use versus reusable duodenoscopes. Gastrointest Endosc 2022; 96: 1002-1008
29 Ponchon T, Pioche M. Reprocessing single-use devices: A new season in a long-running show? A European perspective. Endoscopy 2017; 49: 1195-1197
30 Fang L, Pinder A, Cooper G. et al. Mitigating the environmental impact of plastic PPE: more than just disposal. BMJ 2021; 372: n752
31 López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V. et al. Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact. Gut 2023; 72: 1692-1697
32 Tao Y, Steckel D, Klemeš JJ. et al. Trend towards virtual and hybrid conferences may be an effective climate change mitigation strategy. Nat Commun 2021; 12: 7324
33 An N, Huang C, Shen Y. et al. Challenges of carbon emission reduction by the workshop education pattern. Heliyon 2023; 9: e13404
34 Kotcher J, Maibach E, Miller J. et al. Views of health professionals on climate change and health: a multinational survey study. Lancet Planet Health 2021; 5: e316-e323
35 Sarfaty M, Kreslake J, Ewart G. et al. Survey of international members of the American Thoracic Society on climate change and health. Ann Am Thorac Soc 2016; 13: 1808-1813

Supplementary Material

Supplementary material