Environmental footprint of gastrointestinal endoscopy services: a systematic review

Background – Gastrointestinal (GI) endoscopy is a significant contributor to healthcare-related climate change due to high procedure volumes, intensive decontamination processes, and reliance on single-use products. This systematic review aims to synthesize the current evidence on the environmental impact of GI endoscopy.  Methods – MEDLINE, Embase and Web of Science were systematically searched up to May 2025 for studies assessing the environmental impact of GI endoscopy. Two reviewers independently performed study selection, data extraction, and quality assessment. The PRISMA guidelines were followed.  Results – A total of 28 studies were included. Most studies assessed carbon emissions; only five studies (18%) examined environmental impacts beyond greenhouse gas emissions. The largest contributors to emissions were patient travel, energy use, and procedure-related products, while waste had limited impact. Overall, scope 3 emissions accounted for the majority of total emissions, though reporting across different emission scopes was inconsistent. In line with heterogeneity in methodology, per–procedure emissions ranged from 5.4 to 73.2 kg CO2 equivalent. Twenty-one studies (75%) were judged to have a high risk of bias.  Discussion – Current evidence on the environmental impact of GI endoscopy services is fragmented, methodologically inconsistent, and often limited in coverage. Emissions were dominated by patient travel, energy use and procedure-related products. Broader and more standardized environmental assessments are needed to guide the transition to low-carbon, sustainable GI endoscopy. 

Publication History

Received: 02 August 2025

Accepted after revision: 29 October 2025

Accepted Manuscript online:
05 November 2025