Can we reduce environmental impact of Endoscopic Submucosal Dissection by removing face to face consultation without reducing the procedure quality : an analysis from a multicenter prospective database

Aims Transport is one of the major sources of environmental impact of endoscopy. An ESD has an impact of 73.2 kg CO2 eq with almost half of this impact is attributed to patient transportation. Choosing types of consultations such as off-site examinations could help to reduce the ecological impact. This study aimed to verify if different types of consultations can lead to similar ESD outcome.

Methods We used the prospective national database of ESD cases the French group FECCO to analyze the outcomes of ESD procedures on 1-year (31/07/2023-31/07/2024[I1]. We took in account patients’ clinical parameters, type of consultations and transport. Main endpoint was the comparison of resective outcomes and environmental impacts of ESD depending on the consultation with 3 groups:face-to-face either with a physician in the distant resecting center (FFD), or in the local referring center (FFL), and remotely virtual consultation (RV). Data concerning the global environmental impact of ESD and mean distances of transport were retrieved from the RESECT environmental post hoc study

Results Among 1809 procedures, 1458 patients were informed by the endoscopists using FFD (85.4%) and 249 using teleconsultations with almost null carbon footprint (14.6%). For the anesthesiology consultation (Data for 1747 patients), 1348 were FFD (77.2%) including 946 the same day of endoscopist consultation and 402 additional ones, 359 (20.5%) using FFL, 36 using VR (2.1%) and 4 had no additional anesthesiology consultation. The mean distance from patient’s residence and local center was 34 Km and from referring center 175 km (round trips). On site consultations lead to a cumulative transport of 325500 kms representing 65 tons of CO2e (36 kgCO2e per patient). Only 7 patients used the public transportation in the 1481 available data (0.5%). The procedure itself represents an additional 316575 km and 63 tons of CO2e (34.8 kg CO2e/patient). When comparing the group with FFD and VR consultations, there was no significant difference for lesion characteristics, age,and therapies but ASA score was slightly inferior (2.12 vs 2.24) in the VR group (p=0.04). ESD outcomes in terms of effectiveness were respectively 96.6 and 96.0% (p=0.57) for En bloc resection rate, and 89.4 vs 92.7% (p=0.19) for R0 resection rate in the FFD and VR groups. Outcomes in terms of safety were respectively 7.6 and 8.4% (p=0.76) for perforation rate, 1.22 and 1% (p=0.99) for surgery for adverse event rate, 5.9, and 2.0% (p=0.04) for delayed bleeding rate in the FFD and VR groups. The mean duration and speed of ESD were respectively 60 min and 36.4 mm2/min for FFD and 61 min and 38 mm2/min for VR (p>0.2).

Conclusions ESD performed after teleconsultation has the same effectiveness and safety profile than after face-to-face consultation. Organization of care is urgently needed to facilitate teleconsultation to avoid unnecessary environmental burden.

Publication History

Article published online:
27 March 2025