Carbon Footprint of Diagnostic Modalities Used in Inflammatory Bowel Disease Care: The EVERGREEN ‐ IBD Study (EVERGREEN‐IBD: Evaluating Value, Emissions, Resource Use, and GREEN diagnostics in IBD)

Background Healthcare contributes 4.4%–5% of global greenhouse gas emissions. Inflammatory bowel disease (IBD) requires repeated diagnostic investigations throughout a patient's lifetime, adding to healthcare's environmental footprint. However, the carbon footprint and cost of IBD diagnostic modalities have not been systematically compared Aims To quantify per‐procedure emissions and relative costs of IBD diagnostics and model potential savings from intestinal ultrasound (IUS) when clinically appropriate. Methods This prospective observational study quantified operational emissions at AIG Hospitals, Hyderabad, India, during December 2025 using the Greenhouse Gas Protocol, institutional data, and a three‐state power model. Procedures included laboratory tests (27,330), colonoscopy/enteroscopy (1290), CT (1520), MRI (589), and IUS (923). Sensitivity analyses were performed to assess the robustness of emission estimates by varying assumptions regarding infrastructure allocation, equipment power consumption, procedure volumes, and electricity grid emission factors. Results Emissions ranged from 0.462 kg CO 2 e per laboratory test to 21.25 kg CO 2 e per MRI. IUS (0.850 kg CO 2 e) was the lowest‐carbon imaging modality, with 4.6‐, 6.8‐, and 25.0‐fold lower emissions than colonoscopy/enteroscopy, CT, and MRI, respectively. Cross‐sectional imaging contributed 53.7% of total emissions (39,778 kg CO 2 e), versus 2.0% for IUS. Costs increased with emissions. When clinically appropriate, substituting IUS for colonoscopy or MR enterography could reduce per‐procedure emissions by 78.0% and 96.0%, respectively. Conclusions Carbon emissions and cost rise together across IBD diagnostics; when clinically appropriate, IUS is the lowest‐carbon, lowest‐cost imaging modality. Patient‐level studies are needed to confirm modelled savings. Trial Registration ClinicalTrials.gov NCT07431983