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Original research
Targeted intervention to achieve waste reduction in gastrointestinal endoscopy
  1. João A Cunha Neves1,2,
  2. Joana Roseira1,2,
  3. Patrícia Queirós1,2,
  4. Helena Tavares Sousa1,2,
  5. Gianluca Pellino3,4,
  6. Miguel F Cunha2,5
  1. 1 Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
  2. 2 ABC—Algarve Biomedical Centre, University of Algarve, Faro, Portugal
  3. 3 Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
  4. 4 Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
  5. 5 Colorectal Disease Group—Department of General Surgery, Algarve University Hospital Centre, Portimão, Portugal
  1. Correspondence to Dr João A Cunha Neves, Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal; joaoacunhaneves{at}


Objective Endoscopy is healthcare’s third largest generator of medical waste in hospitals. This prospective study aimed to measure a single unit’s waste carbon footprint and perform a pioneer intervention towards a more sustainable endoscopy practice. The relation of regulated medical waste (RMW; material fully contaminated with blood or body fluids or containing infectious agents) versus landfill waste (non-recyclable material not fully contaminated) may play a critical role.

Design In a four-stage prospective study, following a 4-week observational audit with daily weighing of both waste types (stage 1), stage 2 consisted of a 1-week intervention with team education of waste handling. Recycling bins were placed in endoscopy rooms, landfill and RMW bins were relocated. During stages 3 (1 month after intervention) and 4 (4 months after intervention), daily endoscopic waste was weighed. Equivalence of 1 kg of landfill waste to 1 kg carbon dioxide equivalent (CO2e) and 1 kg of RMW to 3kgCO2e was assumed. Paired samples t-tests for comparisons.

Results From stage 1 to stage 3, mean total waste and RMW were reduced by 12.9% (p=0.155) and 41.4% (p=0.010), respectively, whereas landfill (p=0.059) and recycling waste increased (paper: p=0.001; plastic: p=0.007). While mean endoscopy load was similar (46.2 vs 44.5, p=0.275), a total decrease of CO2e by 31.6% (138.8kgCO2e) was found (mean kgCO2e109.7 vs 74.9, p=0.018). The annual reduction was calculated at 1665.6kgCO2e. All these effects were sustained 4 months after the intervention (stage 4) without objections by responsible endoscopy personnel.

Conclusion In this interventional study, applying sustainability measures to a real-world scenario, RMW reduction and daily recycling were achieved and sustained over time, without compromising endoscopy productivity.

  • endoscopy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • GP and MFC are joint senior authors.

  • Twitter @JoaoCunhaNeves, @RoseiraJoana, @GianlucaPellino, @MiguelFCunha86

  • GP and MFC contributed equally.

  • Contributors JACN, JR, PQ, HTS and MFC conceived and designed the study. JACN and JR acquired the data and did the statistical analyses. All authors analysed and interpreted the data. JACN wrote the manuscript, and all authors critically revised the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for the accuracy of the work. MFC and GP supervised the study and should be both considered cosenior authors of the manuscript. JACN is the article 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 None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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