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Original research
Production and possible reduction of greenhouse gases produced during GI endoscopy activity: a systematic review of available literature
  1. Abhilash Perisetti1,
  2. Madhav Desai2,
  3. Michael J Bourke3,
  4. Ian Penman4,
  5. Alessandro Repici5,6,
  6. Duvvur Nageshwar Reddy7,
  7. Hisao Tajiri8,
  8. Douglas K Rex9,
  9. Cesare Hassan5,6,
  10. Prateek Sharma1,10
  1. 1 Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
  2. 2 Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
  3. 3 Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
  4. 4 Gastroenterology and Hepatology, Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
  5. 5 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
  6. 6 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
  7. 7 Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
  8. 8 Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
  9. 9 Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
  10. 10 Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Missouri, USA
  1. Correspondence to Professor Prateek Sharma, Kansas City VA Medical Center, Kansas City, MO 64128, USA; psharma{at}


Background and aims Greenhouse gases (GHGs) that trap heat in the atmosphere are composed of carbon dioxide (CO2), methane, nitrous oxide and fluorinated gases (synthetic hydrofluorocarbons, perfluorocarbons and nitrogen trifluoride). In the USA, the health sector accounts for 8.5% of total GHG emissions. The primary objective of this systematic review was to critically analyse the carbon emissions data from GI endoscopic activity.

Design The GI endoscopy carbon cycle was evaluated at preprocedural, intraprocedural and postprocedural levels. We performed a systematic literature search of articles published on these issues until 30 June 2022 and discussed these available data on endoscopy unit GHG carbon cycle, barriers to reduce GHG emissions and potential solutions. The inclusion criteria were any full-text articles (observational, clinical trials, brief communications, case series and editorials) reporting waste generation from GI endoscopy. Abstracts, news articles and conference proceedings were excluded.

Results Our search yielded 393 records in PubMed, 1708 in Embase and 24 in Google Scholar. After application of inclusion and exclusion factors, we focused on 9 fulllength articles in detail, only 3 of them were cross-sectional studies (all from the USA), the others reviews or position statements. Therefore, the quality of the studies could not be assessed due to heterogeneity in definitions and amount of emissions.

Conclusions Recognition of carbon emissions generated by GI endoscopy activity is critical. Although multiple limitations exists for quantification of these emission, there is an urgent need for collecting proper data as well as examining novel methods for reduction of these emissions for a sustainable endoscopic practices in the future.

  • endoscopy
  • environmental health
  • gastrointestinal pathology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @AbhilashPerise1, @GastronauIan

  • Correction notice This article has been corrected since it published Online First. The author affiliations have been updated.

  • Contributors Conception and design: AP, PS. Literature search: AP, MD. First draft: AP. Critical revision and editing: all authors. Final approval: all authors. AP is responsible for the overall content of the article and accepts full responsibility for the work and/or the conduct of the study.

  • 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 AP, MJB, IP, AR, DNR, HT, DKR, CH: none. MD: Grant support: Intercept Pharma. PS: Consultant-Bausch, Boston Scientific Corporation, CDx Labs, Covidien LP, Exact Sciences, Fujifilm Medical Systems USA, Inc, Lucid, Lumendi, Medtronic, Phathom, Olympus, Takeda, Samsung BioepisGrant/Contract-Cosmo Pharmaceuticals, Covidien, Docbot, ERBE USA, Inc, Fujifilm Holdings America Corporation, Ironwood Pharmaceuticals, Inc., Medtronic USA, Inc.

  • 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.

  • 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.