Carbon Footprint of Gastrointestinal Endoscopy: A Prospective Procedure-Level Environmental Assessment

Objective: Gastrointestinal endoscopy (GIE) contributes to healthcare-related greenhouse gas emissions; however, prospective procedure-level data remain limited. This study quantified procedure-level emissions and waste and examined operational factors associated with intrinsic (non-transportation-related) emissions.

Methods: This prospective environmental study included 1300 consecutive GIE procedures performed in adults at a tertiary referral center. Activity data included electricity, water, carbon dioxide insufflation, supplemental oxygen, selected single-use accessories, waste, and patient transportation. A partial cradle-to-gate life-cycle assessment was performed for 4 accessory categories. Emissions were calculated within the Greenhouse Gas Protocol framework. Exploratory multivariable regression examined associations with intrinsic emissions.

Results: Mean total emissions were 18.22 ± 4.10 kg CO2e per procedure. Patient transportation was the largest contributor (12.81 kg CO2e; 70.3%). Mean intrinsic emissions were 5.41 ± 1.80 kg CO2e per procedure. Modeled upstream emissions from 4 accessory categories contributed 2.60 kg CO2e, representing 48.0% of intrinsic and 14.3% of total emissions. Therapeutic procedures had higher intrinsic emissions than diagnostic procedures (7.01 ± 2.40 vs 4.41 ± 1.50 kg CO2e; P < .001) and generated more waste (1.20 ± 0.30 vs 0.60 ± 0.20 kg; P < .001). Longer procedure duration and greater modeled accessory use were associated with higher intrinsic emissions; procedure category was not associated after adjustment. The model explained 68% of the variance (adjusted R2 = 0.68).

Conclusion: Patient transportation dominated total emissions, whereas the 4 modeled single-use accessory categories constituted the largest intrinsic component. Findings should be interpreted within the single-center and partial life-cycle boundaries.

Cite this article as: Özden Y, Kaldırım Armutçuoğlu Y, Kani HT. Carbon footprint of gastrointestinal endoscopy: a prospective procedure-level environmental assessment. Cerrahpaşa Med J 2026, 50, 0067, doi: 10.5152/cjm.2026.26067.