P0568Sustainable monitoring in inflammatory bowel disease: comparative carbon, energy, waste, and cost of intestinal ultrasound versus colonoscopy in a 200-patient cohort

Abstract Background Treat-to-target strategies in inflammatory bowel disease (IBD) have increased reliance on colonoscopy, raising concerns regarding environmental sustainability and resource use. Intestinal ultrasound (IUS) is a non-invasive alternative for routine monitoring. This study compared the environmental impact and cost of IUS versus colonoscopy when used to inform therapeutic decisions. Methods In this single-center retrospective cohort (2022–2024), we evaluated 200 adults with IBD who underwent both IUS and colonoscopy for therapeutic monitoring. The functional unit was one monitoring episode guiding clinical management. For each modality, we quantified carbon dioxide equivalent emissions (CO2e), energy use (kWh), and disposable waste (g) within predefined system boundaries including room HVAC (Heating, Ventilation and Air Conditioning), device power, reprocessing, CO2 insufflation, and consumables. Procedural cost (€) was assessed as a secondary outcome. A patient-level model estimated cumulative impact across ten monitoring cycles, comparing an IUS + fecal calprotectin (FCP 250 μg/g) strategy with colonoscopy for all patients. Results Compared with IUS, colonoscopy required +0.91 kWh (95% CI 0.86–0.95), emitted +2.9 kg CO2e (2.8–3.0), and generated +212 g (200–226) of disposable material per procedure (all p 0.001). IUS therefore demonstrated ∼95% lower energy use, ∼100-fold lower CO2e emissions, and ∼85% less disposable waste (Table 1). In longitudinal modelling over ten monitoring cycles, an IUS-first strategy reduced cumulative CO2e by ∼40% and lowered per-patient monitoring costs by ∼40% (both p 0.05) (Figure 1). Conclusion IUS markedly decreases carbon emissions, energy demand, waste generation, and cost compared with colonoscopy, while still enabling high-quality, timely treatment decisions. An IUS + fecal calprotectin-based monitoring strategy may offer a pragmatic, high-value, and low-carbon approach for sustainable IBD care. References: 1. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD Internet. Gastroenterology 2021;160:1570–1583.cited 2025 Jul 3 Available from: https://pubmed.ncbi.nlm.nih.gov/33359090/ 2. Cammarota G, Laterza L, Bibbò S, et al. Review Article: Green Management of IBD-New Paradigms for an Eco-Friendly Approach Internet. Aliment Pharmacol Ther 2025;61cited 2025 Jul 3 Available from: https://pubmed.ncbi.nlm.nih.gov/39552383/ 3. Sebastian S, Dhar A, Baddeley R, et al. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy Internet. Gut 2023;72:12–26.cited 2025 Jul 3 Available from: https://pubmed.ncbi.nlm.nih.gov/36229172 4. Tan YY, Cheong EHT, Lim CT, et al. Clinical and environmental impact of intestinal ultrasound for inflammatory bowel disease: a tertiary centre experience in Southeast Asia Internet. Scand J Gastroenterol 2025;60cited 2025 Oct 11 Available from: https://pubmed.ncbi.nlm.nih.gov/40698902/ 5. Massironi S, Zilli A, Furfaro F, et al. Systematic Review: Ultrasound Goes Echo-Decarbonising Inflammatory Bowel Disease Care Through Intestinal Ultrasound Internet. Aliment Pharmacol Ther 2025;cited 2025 Oct 11 Available from: https://pubmed.ncbi.nlm.nih.gov/40985233/ Conflict of interest: Dr. Dal Buono, Arianna: speaker’s fees from AbbVie, Alphasigma, Ferring, Lilly, Janssen, and Celltrion Gabbiadini, Roberto: speaker’s fees from Pfizer, MSD, Eli-Lilly, Janssen, Takeda, and Celltrion and consulting fees from Pfizer. Privitera, Giuseppe: Consultant fee from Johnson & Johnson Masoni, Benedetta: No conflict of interest Migliorisi, Giulia: No conflict of interest Farinola, Valeria: No conflict of interest Franchellucci, Gianluca: No conflict of interest Bezzio, Cristina: Personal Fees: I received consulting/advisory board/lecture fees from Alfa Sigma, AbbVie, Celltrion, Eli Lilly, Ferring, Gilead, Johnson & Johnson MSD, Pfizer and Takeda Armuzzi, Alessandro: Consulting fees from AbbVie, Abivax, Alfa Sigma, Astra Zeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Eli-Lilly, Enthera, Ferring, Galapagos, Gilead, Giuliani, Janssen, Lionhealth, MSD, Nestlé, Pfizer, Protagonist Therapeutics, Roche, Samsung Bioepis, Sanofi, Sandoz, Takeda, Teva Pharmaceuticals, Tillots Pharma Speaker’s fees from AbbVie, Abivax, AG Pharma, Alfa Sigma, Biogen, Bristol-Myers Squibb, Celltrion, Eli-Lilly, Ferring, Galapagos, Gilead, Janssen, Lionhealth, MSD, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda, Teva Pharmaceuticals Research support from Biogen, MSD, Takeda, and Pfizer Non-financial support from Abbvie, Janssen, MSD, Pfizer, Takeda