Environmental footprint of gastrointestinal endoscopy services: a systematic review.

Background: Gastrointestinal (GI) endoscopy is a significant contributor to health care-related climate change due to high procedure volumes, intensive decontamination processes, and reliance on single-use products. This systematic review aimed 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: 28 studies were included. Most studies assessed carbon emissions; only four studies (14%) examined environmental impacts beyond greenhouse gas emissions. The largest contributors to emissions were patient travel, energy use, and procedure-related products, whereas 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 carbon dioxide equivalent. Overall, 21 studies (75%) were judged to have a high risk of bias. Conclusion: 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.