P0223Intestinal ultrasound guided management of patients with inflammatory bowel diseases has a significant reduction on carbon emissions

Abstract Background MRI enterography (MRE) and colonoscopy are essential investigations in assessing inflammatory bowel disease (IBD) phenotype and activity. Both are however resource-intensive and contribute significantly to healthcare-related carbon emissions and energy expenditure.1,2 The aim of this study was to systematically assess the impact of implementing intestinal ultrasound (IUS) on CO2 footprint in a tertiary IBD service. Methods A retrospective review was performed of all IUS examinations conducted for IBD assessment at a single tertiary centre in Australia between January 2024 and October 2025. Data collected included patient demographics, diagnosis, prior surgery, impact on management with avoidance of additional imaging and colonoscopy. Current data estimates energy use for MRE at 2457 Wh with associated CO2 emissions of 17.5kg per scan. CO2 emission for colonoscopy is estimated at 56kg per scope. Approximate CO2 emission per IUS is estimated at 0.5kg per scan with energy expenditure 17 Wh.2,3 Estimated CO2 and energy savings were calculated using published Australian data on both colonoscopy and MRE CO2 emission and energy consumption. Results A total of 438 IUS examinations were analyzed. Of these, 234 (53.4%) were in female patients, with a median age of 44 years (IQR: 30-57), 371 (85%) with Crohn’s Disease, 57 (13%) with Ulcerative Colitis and 10 (2%) with pouch-disorders. 191 (43.6%) of patients had undergone a prior intestinal surgery. Two-hundred and twenty-five (51.4%) IUS examinations demonstrated active disease on IUS. Use of IUS avoided 199 MREs and 139 colonoscopies. Avoiding 199 MRE reduced CO2 emission by 3482.5kg. Avoiding 139 colonoscopies reduced CO2 emission by 7784 kg. The total CO2 emission as a result of 438 IUS scans was 219kg. The net reduction in CO2 emission was corresponding to a total CO2 reduction of 11047.5 kg. The energy savings by avoiding 199 MREs was 488,943Wh, energy expenditure as a result of 438 IUS scans was 7446 Wh, the net energy savings were 481,497 Wh. Conclusion The use of IUS in routine IBD management substantially reduced dependence on MRI and colonoscopy, leading to significant reductions in carbon emissions and energy use. Beyond its diagnostic and patient-centred advantages, IUS represents an effective and scalable strategy for upholding environmental sustainability in gastroenterology services. References: 1. Cai S, Lim CT, Tan YY, Tay YX, Cheong EHT, Tan MTK. Intestinal ultrasound for Crohn’s disease: A single-centre experience in cost and carbon emissions reduction through transdisciplinary collaboration. Radiography (Lond). 2025;31(5):103114. doi:10.1016/j.radi.2025.103114 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? J Crohns Colitis. 2025;19(suppl 1):i894. doi:10.1093/ecco-jcc/jjae190.0572 3. Massironi S, Zilli A, Furfaro F, Allocca M, Peyrin-Biroulet L, Jairath V, Danese S. Systematic review: Ultrasound goes echo-decarbonising inflammatory bowel disease care through intestinal ultrasound. Aliment Pharmacol Ther. 2025;62(10):966-982. doi:10.1111/apt.70385 Conflict of interest: Ford, Timothy: No conflict of interest Mian, Ibrahim: None Haig, Adam: No conflict of interest Subhaharan, Deloshaan: Mohsen, Waled: No conflict of interest Kakkadasam Ramaswamy, Pradeep: None