Hep needed please!!

Alex Bonner's picture

Dear all,

I have just joined this network. I work in bowel cancer screening and my colleagues in endoscopy at UHL (Leicester) have agreed for me to do some fact finding into how we can look at being "greener" in the way we do things in endoscopy. Has anyone any experience / knowledge / resources in how we would conduct this process which they would be happy to share? I imagine it would start with some form of audit, then action plans etc. We are at the beginning of this process so any guidance would be gratefully received.

Many thanks,

Alex Bonner 


Hi Alex, 

Vivien De Greef's picture

Hi Alex, 

Great to have you on the network! 

We recently ran a Green Ward Competition with Frimley Health NHS, and their Endoscopy unit identified two methods of reducing CO2 use:

  1. Lean procedures - Changing routine practice of leaving the tap of CO2 cylinders open in between procedures to stop litres of CO2 gas escaping.
  2. Low carbon alternatives - exploring the possibility of using air or water during the procedure, rather than CO2.

By switching off CO2 cylinders between procedures, instead of leaving the CO2 cylinder tap open continuously, this lead to an annual forecast saving of 546kgCO2e in Carbon Emissions and £1,226! They are also starting to use water in place of CO2 for insufflation.

We are running a Sustainable Quality Improvement course 15th October, this may be of interest to you (sign ups close tomorrow though!). Participants explore in depth how the SusQI framework can be applied in practice to develop preventative, holistic, lean, low carbon care > You can register/learn more here

Alternatively, we are running a Carbon Footprinting for healthcare course 22nd Oct, where we help health professionals, quality improvement leads and medical students to become carbon literate > You can register/learn more here

Hope this helps!


Green Endoscopy

Bu'Hussain Hayee's picture

Dear Alex


Together with a few colleagues in the BSG, I am moving forward with the Green Endsocopy initiative and did a webinar in August through the BSG on this topic (it should be accessible from the BSG website if one of your team has membership).

I can forward the article we published in Lancet Gastroenterology and Hepatology if that will help but essentially, the idea is to look at all aspects of the endoscopy process and break it down into steps – to identify areas that can be changed for sustainable alternatives.


An easy win is having recycling bins in each endoscopy room to collect the plastic and paper packaging from daily activities. Anything that isn’t contaminated can be put into the bins. Orange bag waste costs £600 per ton to dispose of, while recycling waste costs £60, plus the reduction in emissions from not incinerating the waste (which is what happens to the orange bag waste).


Reducing paper by emailing endoscopy reports to GPs is another idea.


It is more about looking at the process of doing an endoscopy in a step-wise fashion, then identifying places to intervene with carbon-reducing alternatives.

This diagram below a start, but is by no means exhaustive.


The big thing we lack right now is data. So my ‘ask’ to you is that, whatever you decide to implement, please collect as much data as you can (eg. weight or number of bags of recycled waste per endoscopy room, per week; costs; etc). The CSH can help with carbon footprinting and estimating tCO2e etc.


Please do keep in touch!!





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