The Carbon Footprint Study of Colonoscopy

NCT07171853 | Recruiting DMC

• 1 other identifier: RP028
• Study Type: observational
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

With global warming intensifying, GI endoscopy is among the top three greenhouse gas-emitting medical procedures. Colonoscopy, a cornerstone for colorectal cancer (CRC) screening, significantly contributes to the carbon footprint (CF). This study quantifies CO₂ emissions in different steps of colonoscopy and evaluates the environmental impact of common polypectomy techniques to establish baseline CF data and identify opportunities for mitigation. This study included patients undergoing colonoscopy for CRC screening. CO₂ emissions were comprehensively measured at each step of the procedure (pre-, during, and post-colonoscopy), including energy consumption, all equipment and medications, waste management, and endoscopy reprocessing. Emission data were also collected for common polypectomy techniques, including cold forceps biopsy (CFB), cold snare polypectomy (CSP), hot snare polypectomy (HSP), and hot snare endoscopic mucosal resection (EMR), all performed according to standard polypectomy protocols.

Conditions

Colonoscopy

Keywords

Carbon footprint; Colonoscopy; Colonic polypectomy

Outcome Measures

Primary Outcomes (1)

• Carbon footprint of colonoscopy for colorectal cancer screening and various techniques of colonic polypectomy

  To calculate carbon footprint from colonoscopy for colorectal cancer screening and various techniques of colonic polypectomy

  4 months after start this study

Study Arms (2)

Diagnostic Colonoscopy

Patient receiving diagnostic colonoscopy for colorectal cancer screening without therapeutic intervention

Colonoscopy with colonic polypectomy

Patient receiving colonoscopy with various techniques of colonic polypectomy

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients aged 18-80 years who received a colonoscopy at King Chulalongkorn Memorial Hospital

You may qualify if:

• Patients aged 18-80 years

You may not qualify if:

• Patient status grade III-V according to the American Society of Anesthesiologists (ASA)
• Poor bowel preparation (grade \<6 in the Boston Bowel Preparation Scale \[BBPS\])
• Endoscopic JNET type III or suspicion of malignancy
• Hematologic or coagulation disorders, Plt\<140,000/mcL, INR\>1.5
• anti-platelet/anticoagulant medication that could not be paused as recommended in the current guideline
• Emergency colonoscopy, GI bleeding, unstable vital sign, critical ill patient
• Inflammatory bowel disease
• Pregnancy
• Severe cardiopulmonary disease
• Severe infection
• Malignancy
• History of allergy to IV sedative medication

Sponsors & Collaborators

• King Chulalongkorn Memorial Hospital: lead

Study Sites (1)

King Chulalongkorn Memorial Hospital

Bangkok, Bangkok, 10330, Thailand

RECRUITING

Related Publications (22)

• Steubing B, de Koning A, Merciai S, Tukker A. How do carbon footprints from LCA and EEIOA databases compare? A comparison of ecoinvent and EXIOBASE. Journal of Industrial Ecology. 2022;26(4):1406-22.

  BACKGROUND

• Turner DA, Williams ID, Kemp S. Greenhouse gas emission factors for recycling of source-segregated waste materials. Resources, Conservation and Recycling. 2015;105:186-97.

  BACKGROUND

• McGinnis S, Johnson-Privitera C, Nunziato JD, Wohlford S. Environmental Life Cycle Assessment in Medical Practice: A User's Guide. Obstet Gynecol Surv. 2021 Jul;76(7):417-428. doi: 10.1097/OGX.0000000000000906.

  PMID: 34324694 BACKGROUND

• Sevigne-Itoiz E, Mwabonje O, Panoutsou C, Woods J. Life cycle assessment (LCA): informing the development of a sustainable circular bioeconomy? Philos Trans A Math Phys Eng Sci. 2021 Sep 20;379(2206):20200352. doi: 10.1098/rsta.2020.0352. Epub 2021 Aug 2.

  PMID: 34334023 BACKGROUND

• Yu X, Tan C. China's process-related greenhouse gas emission dataset 1990-2020. Sci Data. 2023 Jan 25;10(1):55. doi: 10.1038/s41597-023-01957-y.

  PMID: 36697420 BACKGROUND

• Rodriguez de Santiago E, Dinis-Ribeiro M, Pohl H, Agrawal D, Arvanitakis M, Baddeley R, Bak E, Bhandari P, Bretthauer M, Burga P, Donnelly L, Eickhoff A, Hayee B, Kaminski MF, Karlovic K, Lorenzo-Zuniga V, Pellise M, Pioche M, Siau K, Siersema PD, Stableforth W, Tham TC, Triantafyllou K, Tringali A, Veitch A, Voiosu AM, Webster GJ, Vienne A, Beilenhoff U, Bisschops R, Hassan C, Gralnek IM, Messmann H. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy. 2022 Aug;54(8):797-826. doi: 10.1055/a-1859-3726. Epub 2022 Jul 8.

  PMID: 35803275 BACKGROUND

• Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. Waste Manag Res. 2018 Jan;36(1):39-47. doi: 10.1177/0734242X17739968. Epub 2017 Nov 14.

  PMID: 29132259 BACKGROUND

• Ferlitsch M, Hassan C, Bisschops R, Bhandari P, Dinis-Ribeiro M, Risio M, Paspatis GA, Moss A, Libanio D, Lorenzo-Zuniga V, Voiosu AM, Rutter MD, Pellise M, Moons LMG, Probst A, Awadie H, Amato A, Takeuchi Y, Repici A, Rahmi G, Koecklin HU, Albeniz E, Rockenbauer LM, Waldmann E, Messmann H, Triantafyllou K, Jover R, Gralnek IM, Dekker E, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy. 2024 Jul;56(7):516-545. doi: 10.1055/a-2304-3219. Epub 2024 Apr 26.

  PMID: 38670139 BACKGROUND

• Iwatate M, Sano Y, Tanaka S, Kudo SE, Saito S, Matsuda T, Wada Y, Fujii T, Ikematsu H, Uraoka T, Kobayashi N, Nakamura H, Hotta K, Horimatsu T, Sakamoto N, Fu KI, Tsuruta O, Kawano H, Kashida H, Takeuchi Y, Machida H, Kusaka T, Yoshida N, Hirata I, Terai T, Yamano HO, Nakajima T, Sakamoto T, Yamaguchi Y, Tamai N, Nakano N, Hayashi N, Oka S, Ishikawa H, Murakami Y, Yoshida S, Saito Y; Japan NBI Expert Team (JNET). Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc. 2018 Sep;30(5):642-651. doi: 10.1111/den.13065. Epub 2018 Jun 26.

  PMID: 29603399 BACKGROUND

• The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3-43. doi: 10.1016/s0016-5107(03)02159-x. No abstract available.

  PMID: 14652541 BACKGROUND

• ASGE Standards of Practice Committee; Early DS, Ben-Menachem T, Decker GA, Evans JA, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Maple JT, Sharaf RS, Dominitz JA, Cash BD. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012 Jun;75(6):1127-31. doi: 10.1016/j.gie.2012.01.011. No abstract available.

  PMID: 22624807 BACKGROUND

• Cunha Neves JA, Rodriguez de Santiago E, Aabakken L. Approaches for greening endoscopy and reducing waste. Gut. 2023 Nov 24;72(12):2204-2206. doi: 10.1136/gutjnl-2023-330917. No abstract available.

  PMID: 37977580 BACKGROUND

• Brown JJ, Asumeng CK, Greenwald D, Weissman M, Zauber A, Striplin J, Weng O, List JM, Farley SM, Winawer SJ. Decreased colorectal cancer incidence and mortality in a diverse urban population with increased colonoscopy screening. BMC Public Health. 2021 Jun 30;21(1):1280. doi: 10.1186/s12889-021-11330-6.

  PMID: 34193094 BACKGROUND

• Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH. Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut. 2018 Feb;67(2):291-298. doi: 10.1136/gutjnl-2016-312712. Epub 2016 Oct 12.

  PMID: 27733426 BACKGROUND

• Han J, Tan Z, Chen M, Zhao L, Yang L, Chen S. Carbon Footprint Research Based on Input-Output Model-A Global Scientometric Visualization Analysis. Int J Environ Res Public Health. 2022 Sep 9;19(18):11343. doi: 10.3390/ijerph191811343.

  PMID: 36141618 BACKGROUND

• Maurice JB, Rochford A, Marshall S, Sebastian S, Dhar A, Hayee B; Green Endoscopy group. Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterol. 2021 Jun 7;13(4):342-345. doi: 10.1136/flgastro-2021-101874. eCollection 2022. No abstract available.

  PMID: 35722605 BACKGROUND

• Park SB, Cha JM. Gastrointestinal endoscopy's carbon footprint. Clin Endosc. 2023 May;56(3):263-267. doi: 10.5946/ce.2023.003. Epub 2023 Mar 31.

  PMID: 36997185 BACKGROUND

• Lacroute J, Marcantoni J, Petitot S, Weber J, Levy P, Dirrenberger B, Tchoumak I, Baron M, Gibert S, Marguerite S, Huppertz J, Gronier O, Derlon A. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy. 2023 Oct;55(10):918-926. doi: 10.1055/a-2088-4062. Epub 2023 May 8.

  PMID: 37156511 BACKGROUND

• Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J. 2021 Mar;8(1):e85-e91. doi: 10.7861/fhj.2020-0080.

  PMID: 33791483 BACKGROUND

• Zandalinas SI, Fritschi FB, Mittler R. Global Warming, Climate Change, and Environmental Pollution: Recipe for a Multifactorial Stress Combination Disaster. Trends Plant Sci. 2021 Jun;26(6):588-599. doi: 10.1016/j.tplants.2021.02.011. Epub 2021 Mar 18.

  PMID: 33745784 BACKGROUND

• https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health.

  BACKGROUND

• Information NNCfE. Monthly global climate report for annual 2022. NOAA Washington, DC; 2023.

  BACKGROUND

Central Study Contacts

Phubaet Washrawirul, Medical

CONTACT

660815852932; phubaet.was@chulahospital.org

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assoc. Prof. Dr.

Study Record Dates

• First Submitted: September 6, 2025
• First Posted: September 15, 2025
• Study Start: June 1, 2025
• Primary Completion: September 30, 2025
• Study Completion: October 31, 2025
• Last Updated: September 18, 2025

Record last verified: 2025-09

Locations

TH (1)