Waste Management in Endoscopy

This edition focusses on the critical importance of accurate waste streaming, a key practice to minimise waste and reduce our environmental impact.

The challenge of waste in endoscopy

As a procedure dominated field, gastroenterology generates a substantial amount of waste. In fact, it ranks as the third-largest contributor to healthcare waste by speciality.1 The adoption of single-use items, historically driven by perceived efficiency, cost reduction, and infection control concerns, has only compounded this issue. On average, each endoscopic procedure generates between 1.5 to 2.1 kilogrammes of waste,1–3 a figure that has surged further with the increased use of PPE during the COVID-19 pandemic. Astonishingly, in the United States alone, annual endoscopic waste amounts to a staggering 43,500 metric tonnes, equivalent to covering 130 football fields to a depth of one metre.3 The recent industry drive towards single-use endoscopes could inflate this waste by an additional 40%.3

The importance of proper waste allocation

Waste management extends beyond minimising its volume; it also involves allocating waste to the correct disposal stream. A British study found that hazardous waste disposal (indicated by yellow waste bags and sharps bins) generates between four to six times the carbon emissions of non-hazardous waste (the white bags), and a whopping 50 times more emissions than recycling.4 Additionally, the cost of disposing of hazardous waste can be up to ten times higher than landfill waste.5

The need for waste minimization and accurate streaming

Given these alarming figures, waste minimisation and accurate streaming have become paramount. Surprisingly, not all New Zealand endoscopy units participate in basic recycling efforts. According to the 2022 NZSG Sustainability Survey, 69% of respondents reported their units participated in recycling, while 17% were unsure, and 14% stated their units did not recycle. Barriers such as excessive equipment packaging, lack of recyclable/reusable equipment, and insufficient awareness about waste streaming options were cited as barriers to more sustainable practices.

Can a 'Waste Awareness Campaign' make a difference?

A recent study conducted in a large endoscopy unit in Portugal sought to answer this question.6 They conducted a one-month audit of waste volumes before implementing changes. The intervention included presenting waste data during a pair of seminars on waste handling and segregation, as well as introducing well-labelled paper and plastic recycling bins in each room. Post-intervention audits at one month and four months showed a reduction of 12.9% in total waste and more importantly a striking 41.4% decrease in hazardous waste, with improvements sustained at the four-month mark. These changes resulted in a 31.6% reduction in the carbon footprint of waste and significant cost savings estimated at €6000 per year. Importantly, staff found that these changes did not disrupt their workflow and were helpful in raising awareness about sustainability.

Conclusion

In conclusion, effective waste management within your endoscopy unit is more than just a green initiative; it's a practical way to reduce carbon emissions and cut costs. It also serves as a catalyst for other sustainability efforts and fosters a sense of quick wins to initiate change in other areas. Even if your unit already practices recycling, further education sessions, prominent bin labelling, and intermittent waste streaming audits can yield additional benefits.

Stay tuned for more editions of the NZSG Sustainability Newsletter in each Panui. Thank you for your commitment to a more sustainable future.

Dr Rhys John 
Co-Chair
NZSG Sustainability Working Group 

1. Gayam, S. Environmental Impact of Endoscopy: “Scope” of the Problem. Off. J. Am. Coll. Gastroenterol. ACG 115, 1931 (2020).
2. Lacroute, J. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy (2023)
3. Namburar, S. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 71, 1326–1331 (2022).
4. Rizan, C., Bhutta, M. F., Reed, M. & Lillywhite, R. The carbon footprint of waste streams in a UK hospital. J. Clean. Prod. 286, 125446 (2021).
5. Woods, D. L. et al. Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison. Int. J. Med. Robot. 11, 406–412 (2015).
6. Neves, J. A. C. et al. Targeted intervention to achieve waste reduction in gastrointestinal endoscopy. Gut 72, 306–313 (2023).