What question did this study set out to answer?

The goal was to assess the carbon footprint of diagnostic imaging modalities used in IBD care, especially intestinal ultrasound as a low-carbon alternative.

January 23, 2026

P0529Decarbonizing Inflammatory Bowel Disease (IBD) Care through Intestinal Ultrasound – A Systematic Review.

Puntos clave

The goal was to assess the carbon footprint of diagnostic imaging modalities used in IBD care, especially intestinal ultrasound as a low-carbon alternative.
Conducted a systematic review following PRISMA 2020 guidelines.
Searched databases including PubMed, Scopus, and Embase for studies on diagnostic impacts in IBD from inception to May 2025.
Included studies reporting quantitative or qualitative data on carbon footprint, energy consumption, waste generation, or sustainability metrics.
Synthesized data narratively for insights on diagnostic tools and their environmental costs.
GI endoscopy generates approximately 7.8-56.4 kg CO2-equivalent per procedure, driven by transportation, energy use, and disposables.
CT has a carbon footprint of 7–10 kg CO2e per procedure, possibly extending to ∼20 kg CO2e based on conditions.
MRI is energy-intensive, ranging from 17–22 kg CO2e per scan, increasing up to 200–300 kg CO2e for high-field systems.
Intestinal ultrasound produces only 0.5 to 1.5 kg CO2e per scan, with minimal energy demand and negligible waste.
Adopting IUS can reduce patient travel and associated emissions, promoting sustainable IBD management.

Resumen

Abstract Background Inflammatory bowel disease (IBD) is a chronic, resource-intensive condition requiring repeated diagnostic assessments. Healthcare contributes ∼5% of global greenhouse gas (GHG) emissions, and key diagnostic tools in IBD - gastrointestinal (GI) endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) - are associated with substantial environmental impacts. The environmental burden of these diagnostic pathways, however, remains underappreciated. Inflammatory bowel disease (IBD) is a chronic, resource-intensive condition requiring repeated diagnostic assessments. Healthcare contributes ∼5% of global greenhouse gas (GHG) emissions, and key diagnostic tools in IBD - gastrointestinal (GI) endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) - are associated with substantial environmental impacts. The environmental burden of these diagnostic pathways, however, remains underappreciated. Aim of this study is to systematically assess the carbon footprint and environmental impact of diagnostic imaging modalities commonly used in IBD, with particular focus on intestinal ultrasound (IUS) as a sustainable, low-carbon alternative. Methods A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, and Embase were searched from inception to May 2025 for studies reporting the environmental impact of diagnostic modalities relevant to IBD care (GI endoscopy, CT, MRI, and IUS). Studies providing quantitative or qualitative data on carbon footprint, energy consumption, waste generation, or sustainability metrics were included. Data were synthesized narratively. Results Thirty-one studies were included. GI endoscopy generates approximately 7. 8-56. 4 kg CO2-equivalent per procedure, largely driven by transportation, energy use, and disposables. CT carries a carbon footprint of 7–10 kg CO2e per procedure in direct life cycle assessments, while broader institutional and modeling estimates extend this to ∼20 kg CO2e depending on throughput, protocol, and energy sources. MRI is substantially more energy-intensive, ranging from 17–22 kg CO2e per scan in most studies, and up to 200–300 kg CO2e for high-field (3T) systems when full life cycle impacts are included. In contrast, IUS produces only 0. 5 to 1. 5 kg CO2e per scan, with minimal energy demand and negligible waste. IUS enables point-of-care assessments, reducing patient travel and associated emissions. Conclusion GI endoscopy, CT, and MRI are indispensable in IBD care but carry considerable environmental costs. The broader adoption of intestinal ultrasound offers a clinically effective, low-carbon alternative that can contribute to more sustainable IBD management, aligning with planetary health goals. References: 1. Lenzen M, Malik A, Li M, et al. The environmental footprint of health care: a global assessment. Lancet Planet Health. 2020;4 (7): e271-e279. 2. Nwaezeigwe M, Hanley M, Lakshman K, Sheridan J, Cullen G, Doherty G. P0398 Point of Care Intestinal ultrasound – is it the key to reducing the carbon footprint of IBD Care? Journal of Crohn’s and Colitis. 2025;19 (Supplement₁): i894-i894. 3. Dolinger MT, Kayal M. Intestinal Ultrasound Is the Ideal Patient-Centric, Point-of-Care Tool for Clinical Decision Making in the Inflammatory Bowel Disease Practice. In: Crohns Colitis 360. Vol 5. England2023: otad029. 4. Dolinger MT, Kayal M. Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making. World J Gastroenterol. 2023;29 (15): 2272-2282. 5. Martin M, Mohnke A, Lewis GM, Dunnick NR, Keoleian G, Maturen KE. Environmental Impacts of Abdominal Imaging: A Pilot Investigation. J Am Coll Radiol. 2018;15 (10): 1385-1393. Martin M, Mohnke A, Lewis GM, Dunnick NR, Keoleian G, Maturen KE. Environmental Impacts of Abdominal Imaging: A Pilot Investigation. J Am Coll Radiol. 2018;15 (10): 1385-1393. 6. Pohl H, Baddeley R, Hayee B. Carbon footprint of gastroenterology practice. Gut. 2023;72 (12): 2210-2213. 7. McAlister S, McGain F, Petersen M, et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac. 2022;24: 100459. 8. Merkle EM, Bamberg F, Vosshenrich J. The Impact of Modern Imaging Techniques on Carbon Footprints: Relevance and Outlook. Eur Urol Focus. 2023;9 (6): 891-893. Conflict of interest: Prof. Dr. Massironi, Sara: None to declare Zilli, Alessandra: Personal Fees: Speaking and consulting fees from Tillotts, Galapagos, Abbvie, Takeda, Janssen, Alfasigma, Sandoz, Lilly, Pfizer Furfaro, Federica: Grant: IG-IBD Personal Fees: Pfizer, Biogen, J&J, Abbvie, Amgen, Janssen Allocca, Mariangela: Personal Fees: consulting fees from Nikkiso Europe, Mundipharma, Janssen, Abbvie, Pfizer, Ferring, Galapagos, Sandoz, Lilly and Alfasigma Peyrin-Biroulet, Laurent: Grant: Takeda, Fresenius Kabi, Celltrion, Medac, MSD Personal Fees: Abbvie, Abivax, Adacyte, Alimentiv, Amgen, Applied Molecular Transport, Arena, Banook, Biogen, BMS, Celltrion, Connect Biopharm, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Gossamer Bio, GSK, IAC Image Analysis, Index Pharmaceuticals, Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD, Nordic Pharma, Novartis, Oncodesign Precision Medicine, ONO Pharma, OSE Immunotherapeuthics, Pandion Therapeuthics, Par’ Immune, Pfizer, Prometheus, Protagonist, Roche, Samsung, Sandoz, Sanofi, Satisfay, Takeda, Telavant, Theravance, Thermo Fischer, Tigenix, Tillots, Viatris, Vectivbio, Ventyx, Ysopia. Other: SUPPORT TRAVEL: Abbvie, Alfasigma, Amgen, Celltrion, Connect Biopharm, Ferring, Galapagos, Genentech, Gilead, Gossamer Bio, Janssen, Lilly, Medac, Morphic, MSD, Pfizer, Sandoz, Takeda, Thermo Fischer, Tillots. Jairath, Vipul: Consulting Fees: Abbvie, Alimentiv, Amgen, Anaptys Bio, Asahi Kasei, Asieris, Astra Zeneca, Attovia, Blackbird Labs, BMS, Boehringer Ingleheim, Biomebank, Caldera, Calluna, Catalytic Health, Celltrion, Ensho, Enthera, Exeliome Biosciences, Ferring, Fresenius Kabi, Gilead, Granite Bio, GSK, Janssen, Lilly, Merck, Mountainfield, MRM Health, Nxera, Organon, OSE Immunotherapeutics, Pendopharm, Pioneering Medicine, Pfizer, Prometheus, Roche/Genentech, Sanofi, SCOPE, Shattuck Labs, Sorriso, Spyre, Synedgen, Takeda, Teva, Tillotts, Union Therapeutics, Ventus, Ventyx, Vividion, Xencor, Zealand Pharma. Danese, Silvio: Personal Fees: AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc. , Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB Inc. , Vial, Vifor Lecture fees from Abbvie, Amgen, Ferring Pharmaceuticals Inc. , Gilead, Janssen, Mylan, Pfizer, Takeda

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