Abstract Background Colonoscopy has been the gold-standard for assessing disease activity for patients with ulcerative colitis (UC) or Crohn’s disease (CD), but it is invasive and resource-intensive. Intestinal ultrasound (IUS) is now an established non-invasive alternative for monitoring disease activity. We aimed to quantify the number of colonoscopes performed for UC/CD activity assessment over one year and the potential cost savings and reduction in carbon footprint had IUS been used instead. Methods A retrospective review occurred of all colonoscopies performed by the gastroenterology department of a tertiary public hospital from 1st June 2024 to 31st May 2025. Procedures were included if they were performed in patients with established UC or CD for the primary purpose of evaluating disease activity. Patients were deemed not suitable for IUS if the colonoscopy was performed for a stricture dilatation, dysplasia surveillance, clinical trial, consideration of treatment withdrawal, BMI 35kg/m2, complicated surgical history (more than one resection or stoma), or proctitis-limited disease. Cost savings (Australian dollars, AUD) were determined based on the National Efficient Price and national weighted activity unit for a colonoscopy in 2024-2025. Estimated carbon footprint for a colonoscopy was 28. 4kg CO2-equivalent (CO2e) and 0. 5kg CO2e for an ultrasound1, 2. Results A total of 2055 colonoscopies were formed by gastroenterologists over the last 12 months. Of these, 14. 7% (n = 303) were performed for disease activity assessment of UC and CD. Males accounted for 57% (n = 174/303) of this population, and median age was 46. 0 years (IQR: 30. 0-55. 5). From this group, 53% (n = 162/303) were deemed suitable for IUS instead of colonoscopy. Most common reasons for not being suitable for IUS were stricture dilatation (15%, n = 45/303), dysplasia surveillance (8%, n = 25/303), clinical trial (8%, n = 24/303) and BMI (6%, n = 18/303). Cost savings of IUS instead of colonoscopy for suitable patients was estimated to be 457, 530. 12 AUD per annum. Estimated carbon footprint reduction was 4. 52 tonnes CO2e. Conclusion Over 50% of colonoscopies for patients with UC and CD performed over the last 12 months were for disease activity assessment. Replacing these with IUS, where appropriate, could lead to substantial cost savings for healthcare institutions, reduce patient burden, improve service efficiency, and reduce carbon footprint. These findings support boarder implementation of IUS in hospital management strategies. References: 1. Lacroute J, Marcantoni J, Petitot S, et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023;55 (10): 918-926 2. McAlister S, McGain F, Petersen M, et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac 2022;May 3: 24: 100459. Conflict of interest: Crayn, Talia: No conflict of interest Dr. Pudipeddi, Aviv: Aviv Pudipeddi has received speaker honoraria or advisory board fees from AbbVie, Dr Falk Pharma, Ferring, Johnson & Johnson, Pfizer and Takeda.
Crayn et al. (Thu,) studied this question.