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Original research
Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact
  1. Pedro López-Muñoz1,
  2. Rubén Martín-Cabezuelo1,2,
  3. Vicente Lorenzo-Zúñiga1,
  4. Guillermo Vilariño-Feltrer2,
  5. Isabel Tort-Ausina2,3,
  6. Ana Vidaurre2,3,
  7. Vicente Pons Beltran1
  1. 1 Department of Gastroenterology, La Fe Health Research Institute - IIS La Fe, Valencia, Spain
  2. 2 Center for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
  3. 3 CIBER-BBN, ISCIII, Spain
  1. Correspondence to Professor Vicente Lorenzo-Zúñiga, La Fe University and Polytechnic Hospital, Valencia, 46026, Spain; vlorenzozuniga{at}


Objectives GI endoscopy units represent the third largest producers of medical waste. We aimed to determine endoscopic instrument composition and life cycle assessment (LCA) and to assess a sustainability proposal based on a mark on the instruments that identifies parts can be safely recycled or ‘green mark’.

Design Material composition analysis and LCA of forceps, snares and clips from four different manufacturers (A–D) were performed with four different methods. Carbon footprint from production, transportation and end of life of these instruments was calculated. In 30 consecutive procedures, we marked the contact point with the working channel. 5 cm away from that point was considered as green mark. One-week prospective study was conducted with 184 procedures evaluating 143 instruments (75 forceps, 49 snares and 19 haemoclips) to assess the efficacy of this recyclable mark.

Results Composition from different manufacturers varied widely. Most common materials were high global warming potential (GWP) waste (polyethylene, polypropylene and acrylonitrile) and low GWP waste (stainless steel). Significant differences were found for the forceps (0.31–0.47 kg of CO2 equivalent (CO2-eq)) and haemoclips (0.41–0.57 kg CO2-eq) between the manufacturers. Green mark was established 131.26 cm for gastroscope and 195.32 cm for colonoscope. One-week activity produced 67.74 kg CO2-eq. Applying our sustainability intervention, we could reduce up to 27.44% (18.26 kg CO2-eq). This allows the recycling of 61.7% of the instrument total weight (4.69 kg).

Conclusion Knowledge of carbon footprint is crucial to select the most sustainable alternatives because there are large variations between brands. A mark to identify recyclable parts could reduce our environmental impact significantly.


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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  • PL-M and RM-C contributed equally.

  • Contributors PL-M, RM-C, VL-Z, AV and VPB conceived and designed the study. PL-M and RM-C acquired the data and did the statistical analyses. All authors analysed and interpreted the data. PL-M wrote the manuscript. VL-Z, AV and VPB supervised the study and should be considered senior authors of the manuscript. VL-Z is the article guarantor. All authors critically revised the manuscript and approved the final version of the manuscript and agreed to be accountable for the accuracy of the work.

  • 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, conduct, reporting or dissemination plans of this research.

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