Sustainability in Gastroenterology and Digestive Endoscopy: The Ecological Transition of Clinical Practice

Background: Climate change and environmental degradation are increasingly recognized as major determinants of human health. Paradoxically, healthcare systems contribute substantially to greenhouse gas emissions, waste production, water consumption, and pollution. Gastroenterology and digestive endoscopy are particularly concerned because they rely on resource-intensive procedures, complex reprocessing systems, disposable devices, patient transportation, and pharmaceutical use. At the same time, environmental exposures are emerging as important risk factors for digestive diseases, creating a complex interaction between environmental health and gastrointestinal health. Summary: This narrative review explores the concept of sustainability in gastroenterology and digestive endoscopy. First, we describe the bidirectional relationship between environmental degradation and digestive diseases, highlighting how pollution, dietary changes, and the exposome contribute to the rising incidence of gastrointestinal cancers and chronic digestive disorders. We then examine the environmental footprint of digestive healthcare, including colorectal cancer management, endoscopic procedures, endoscope reprocessing, transportation, medical devices, conferences, and training activities. Particular emphasis is placed on colorectal cancer screening as one of the most sustainable strategies in healthcare, since preventing cancer avoids the substantial environmental burden associated with advanced oncologic treatments. The review also discusses the role of telemedicine, appropriate procedural indications, life cycle assessment of medical devices, sustainable conference organization, and simulation-based training as practical approaches to reduce environmental impacts while preserving quality of care. Emerging research frameworks, including environmental reporting standards and eco-design approaches, are presented as key tools for future progress. Key Messages: Sustainability should not be viewed as a constraint but as an opportunity to improve healthcare quality, efficiency, and equity. The most sustainable digestive disease is the one prevented through public health interventions, and the most sustainable endoscopic procedure is the one that is truly necessary. Integrating sustainability into prevention, clinical practice, education, innovation, and research will be essential to protect both digestive health and planetary health in the coming decades.