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Original research
Estimating the environmental impact of disposable endoscopic equipment and endoscopes
  1. Sathvik Namburar1,
  2. Daniel von Renteln2,
  3. John Damianos1,
  4. Lisa Bradish3,
  5. Jeanne Barrett4,
  6. Andres Aguilera-Fish5,
  7. Benoit Cushman-Roisin6,
  8. Heiko Pohl1,4,5
  1. 1 Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
  2. 2 Medicine, Centre Hospitalier de L\'Universite de Montreal, Montreal, Quebec, Canada
  3. 3 Endoscopy unit, Elliot Hospital, Manchester, New Hampshire, USA
  4. 4 Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  5. 5 Department of Gastroenterology, White River Junction VA Medical Center, White River Junction, Vermont, USA
  6. 6 Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
  1. Correspondence to Dr Heiko Pohl, Department of Gastroenterology, VAMC White River Junction, White River Junction, Vermont, USA;{at}


Objective Procedure-intense specialties, such as surgery or endoscopy, are a major contributor to the impact of the healthcare sector on the environment. We aimed to measure the amount of waste generated during endoscopic procedures and to understand the impact on waste of changing from reusable to single use endoscopes in the USA.

Design We conducted a 5-day audit (cross-sectional study) of all endoscopies performed at two US academic medical centres with low and a high endoscopy volume (2000 and 13 000 procedures annually, respectively). We calculated the average disposable waste (excluding waste from reprocessing) generated during one endoscopic procedure to estimate waste of all endoscopic procedures generated in the USA annually (18 million). We further estimated the impact of changing from reusable to single-use endoscopes taking reprocessing waste into account.

Results 278 endoscopies were performed for 243 patients. Each endoscopy generated 2.1 kg of disposable waste (46 L volume). 64% of waste was going to the landfill, 28% represented biohazard waste and 9% was recycled. The estimated total waste generated during all endoscopic procedures performed in the USA annually would weigh 38 000 metric tons (equivalent of 25 000 passenger cars) and cover 117 soccer fields to 1 m depth. If all endoscopic procedures were performed with single-use endoscopes and accounting for reprocessing, the net waste mass would increase by 40%. Excluding waste from ancillary supplies, net waste generated from reprocessing and endoscope disposal would quadruple with only using single-use endoscopes.

Conclusion This quantitative assessment of the environmental impact of endoscopic procedures highlights that a large amount of waste is generated from disposable instruments. Transitioning to single-use endoscopes may reduce reprocessing waste but would increase net waste.

  • environmental health
  • endoscopy
  • endoscopic procedures

Data availability statement

Data are available on reasonable request. All data are under the auspices of Heiko Pohl ( and will be furnished upon reasonable request.

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Data availability statement

Data are available on reasonable request. All data are under the auspices of Heiko Pohl ( and will be furnished upon reasonable request.

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  • Contributors HP and DvR: planned and designed the study. SN, JD, LB, JB, AA-F and HP: data collection. HP, SN and DvR: data analysis. SN and HP: drafted the manuscript. All authors contributed to editing and finalising the manuscript. HP: guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US government.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.