Green Endoscopy: Sustainable Practices and Implementation Strategies for Environmentally Responsible Gastrointestinal Care

Healthcare contributes an estimated approximately 5% of global greenhouse gas emissions, with endoscopic procedures among significant contributors through high energy consumption, extensive single-use consumables, and substantial medical waste generation. Gastrointestinal endoscopy ranks among the highest waste-generating specialties within hospital settings, yet its environmental implications have received limited attention until recently. This narrative review aims to synthesise current evidence on sustainable green endoscopy practices, examine the environmental impact, evaluate existing sustainable interventions, and identify implementation barriers, offering evidence-based recommendations for environmental stewardship within endoscopic services. A comprehensive literature search was conducted across multiple databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Approximately 58 peer-reviewed articles, alongside relevant guidelines, position statements, and grey literature sources, were included. Narrative synthesis with thematic analysis was employed to accommodate the heterogeneity of included sources. Published estimates suggest endoscopic procedures generate approximately 2.5–10 kg CO 2 equivalent per colonoscopy, though these values vary considerably by healthcare setting, reprocessing model, and waste disposal pathway, and should be interpreted as approximate estimates rather than universal benchmarks. A substantial proportion of endoscopy-related waste is directed to incineration or landfill. Potential environmental impact reduction may be achievable through strategic implementation of reusable devices, comprehensive waste segregation protocols, energy-efficient technologies, and artificial intelligence integration, though the evidence base for many individual interventions remains preliminary. Key barriers include financial constraints, clinical safety concerns, regulatory uncertainty, and organisational resistance. Sustainable green endoscopy represents an achievable environmental imperative without compromising patient safety or clinical outcomes. Successful transition requires coordinated efforts across clinical, administrative, and policy levels, combining technological innovation with comprehensive change management strategies addressing organisational culture and professional behaviours. This review offers a framework integrating technological, behavioural, and policy interventions for sustainable endoscopy implementation, aiming to provide evidence-based pathways for healthcare systems at varying resource levels to advance environmental stewardship whilst maintaining clinical excellence. • Endoscopic procedures generate 2.5-10 kg CO 2 per colonoscopy procedure • 90% of endoscopy waste is incinerated or sent to landfill sites • Reusable endoscopes have 75% lower carbon footprint than single-use devices • Switching from sterile to tap water reduces costs by 59% per procedure