Background: Treat-to-target strategies in inflammatory bowel disease (IBD) rely on repeated objective assessments, leading to frequent colonoscopy for therapeutic decision-making.Although effective, endoscopic monitoring is resource-intensive and may not be necessary in all stable patients.Aims: To evaluate the environmental and economic impact of intestinal ultrasound (IUS) compared with colonoscopy for therapeutic monitoring in IBD.Methods: In this single-center retrospective cohort (2022-2024), 200 adults with IBD undergoing both IUS and colonoscopy were analyzed.The functional unit was one monitoring episode.For each modality, we quantified carbon dioxide equivalent emissions (CO 2 e), energy use (kWh), and disposable waste (g) within defined system boundaries.Procedure cost was assessed as a secondary outcome.A patient-level model projected cumulative impact across ten monitoring cycles, comparing an IUS + fecal calprotectin (FCP > 250 g/g) strategy with colonoscopy-for-all.Results: Per procedure, colonoscopy required + 0.91 kWh, emitted + 2.9 kg CO 2 e, and generated + 212 g disposables versus IUS (all p < 0.001).IUS reduced energy use by 95%, CO 2 e by 100-fold, and disposables by 85%.Over ten cycles, an IUS-first strategy reduced cumulative CO 2 e emissions and costs by 40% (both p < 0.05).Conclusions: IUS substantially lowers environmental and economic burden compared with colonoscopy while supporting timely therapeutic decisions.An IUS + FCP-first approach represents a pragmatic, sustainable monitoring strategy in IBD.
Buono et al. (2026) studied this question.