Endoscopy Unit Research Articles

Management of aerosol generation during upper gastrointestinal endoscopy.

In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.

Safety of Endoscopy Units during the COVID-19 Pandemic

Introduction: The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. Material and Methods: This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient’s clinical records and the Trace COVID platform. Results: A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, n = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, n = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, n = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. Discussion/Conclusion: Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.

Quality indicators of colonoscopy care: a qualitative study from the perspectives of colonoscopy participants and nurses

BackgroundQuality of care in colonoscopy is closely related to colonoscopy participants and the nursing workforce in endoscopy-related settings. However, limited data are available on the evaluations and recommendations regarding quality indicators for nursing care by these two groups. Therefore, the aim of this study was to explore the standards and requirements of quality of care in colonoscopy from the perspectives of patients and nurses.MethodWith a descriptive qualitative study, semi-structured interviews were conducted between November 2021 and January 2022 with colonoscopy participants (P = 11) and nursing workforce (N = 7) in the endoscopy unit in a tertiary hospital. The interviews were analyzed using a thematic analysis.ResultsNine major themes emerged according to the structure, process, and outcome care quality model: workforce structure, quality requirements, unit facilities, nursing tools, nursing quality control systems, dynamic assessment and intervention, pre-examination care, strengthening education, and colonoscopy outcomes.ConclusionThe indicator of quality of colonoscopy care should be used to assess and improve current practices to ensure a more direct and sustained impact of colonoscopy care. This study highlights the importance of nurse managers valuing the opinions and reflections of people involved in colonoscopy to improve the quality of colonoscopy care.

Investigation of Eating Habits in Patients with Functional Dyspepsia.

Background:Nutritional habits of patients with functional dyspepsia can affect the progression of functional dyspepsia. We aimed to determine the foods and dietary habits that may cause symptoms of postprandial fullness, early satiety, epigastric pain, and epigastric burning in functional dyspepsia patients.Methods:Sixty functional dyspepsia patients, who were diagnosed according to Rome IV criteria in the endoscopy unit of a gastroenterology institute, were included in the study. Data on the demographic characteristics, anthropometric measurements, nutritional habits, and food consumption frequency questionnaire of functional dyspepsia patients were collected.Results:Postprandial fullness was found more common in those who preferred roasting as a cooking method. There was no significant difference between symptoms and meal frequency. Epigastric burning and pain were found to be more pronounced in women, and alcohol consumption was less in patients who experienced more epigastric pain. In non-smoker participants, the complaint of early satiety was lower. It was found that broccoli, radish, celery, green olives, and olive oil consumption was less in participants who experienced excessive postprandial fullness. Patients with stomach pain consumed less dry fruits, green olives, butter, alcohol, and fast food. It was found that patients with stomach burning consumed less alcohol and fast food.Conclusion:In conclusion, functional dyspepsia patients should avoid or reduce consuming broccoli, radish, celery, green olives, olive oil, dry fruits, and butter which may trigger symptoms. Reducing consumption of these foods, abandoning unhealthy cooking methods such as roasting, reducing smoking, and reducing consumption of alcohol and fast food might be beneficial for relieving symptoms.

Top tips on organizing effective bowel preparation in the endoscopy unit

One of the most important aspects of a high-quality colonoscopy is the bowel preparation, eg, quality of bowel preparation, patient adherence, simple instructions, and reminders. In this issue of Gastrointestinal Endoscopy, Dr Aasma Shaukat provides easy-to-follow tips and instructions on how to organize an effective bowel preparation in the endoscopy unit. She highlights the importance of simple instructions, multiple methods and languages for providing the information, training of personnel who provide the instructions, and periodic review or audit of the methods used.

How the COVID-19 pandemic has affected the colorectal cancer screening in Italy: A minireview.

The coronavirus disease 2019 (COVID-19) pandemic has caused detrimental effects on many aspects of healthcare practice. Screening programs for the commonest malignancies, namely colorectal cancer (CRC), breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection. Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC. In fact, the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection. Besides, colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage. Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed, and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population. A systematic review of the literature was performed, including the PubMed, Scopus, Web of Sciences, and Reference Citation Analysis databases, with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy. We found that reduction of CRC screening activity surpassed 50% in most endoscopic units, with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020 vs the same period of 2019. While the consequences of the discontinuation of endoscopy screening for the prognosis and mortality of CRC will be evident in the next few years, recent data confirm that CRC is currently treated at a more advanced stage than in the pre-COVID-19 era. Since delays in CRC prevention and early diagnosis may translate to increased CRC-specific mortality, world healthcare systems should adopt strategies to maintain the regularity of CRC screening during subsequent peaks of the COVID-19 pandemic, or future events that might hamper screening programs.

Sustainability Prize 1 Green Endoscopy to reduce CO2e generated by endoscopic waste – the GECO2e interventional study

Abstract Aims Endoscopy is healthcare's third-largest waste-generating procedure. This study aimed to measure a single unit's waste carbon footprint and to perform a pioneer evaluation applying the principles of green endoscopy towards a more sustainable unit. Methods This was a 3-stage, prospective study. Stage 1: 4-week observational audit, during which daily endoscopic waste (landfill, biohazard) was weighed. Stage 2: 1-week intervention with presentation of retrieved data and education of the team towards waste handling. Recycling bins were placed in endoscopy rooms, and landfill and biohazard bins were relocated. Stage 3: 4-week post-interventional period, during which daily endoscopic waste was weighed. An engineer-calibrated scale was used. Equivalence of 1kg of landfill waste to 1kg carbon dioxide equivalent (CO2e) and 1kg of biohazard waste to 3kgCO2e was applied. Paired samples T-tests were used for comparisons before and after the intervention. The opinion of the staff was collected. Results Total waste and biohazard waste were diminished by 12.2% (p=0.166) and 41.4% (p=0.010), respectively, whereas landfill waste (p=0.059) and recycling waste increased (paper: p=0.001; plastic: p=0.007). In terms of CO2e, a total decrease of 31.6% (138.8kgCO2e) was found (mean kgCO2e 109.7 vs 74.9, pre- vs post-intervention, p=0.018). Mean endoscopy load was similar (46.2 vs 44.5, p=0.275). The endoscopy unit may achieve an estimated annual reduction of 1665.6kgCO2e. The personnel agreed “the project did not disturb daily work”. Conclusions In this interventional study applying green endoscopy principles to a real-world scenario, biohazard waste reduction and daily recycling were achieved, without compromising endoscopy productivity.

EP-601 Biodegradable stents for benign oesophageal strictures- a single centre experience

Abstract Biodegradable (BD) stents have been used for the management of various oesophageal strictures (ES). The present study aim to evaluate our experience and efficacy of BD stents in benign ES at the endoscopic unit at the James Cook University Hospital, Middlesbrough, UK. Methods A retrospective review of case notes of 9 patients who have undergone endoscopically placement of BD stent for benign ES between March 2010 and November 2020. All 9 patients underwent successful stent placement. None of the patients had previous surgery for their condition. All patients, prior to stenting had oesophageal dilatations, some multiple times. Results Stent placement was successful in all 9 patients. Some patients had stent migration and subsequent re stenting. All patients had benign ES as the cause of dysphagia. One patient had caustic oesophageal stricture, remaining eight had peptic ulceration and GORD as the cause of dysphagia. The median number of dilatations prior to stent placement was 4 (IQR 7), more than the median number of dilatations post stent placement which was 2.0 (IQR: 3.5). Conclusion BD stents offers prolonged dilatation-free interval and reduces the number dilatations in patients with benign oesophageal strictures.

Setting up a three-stage pre-endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study.

ObjectivesBetween May and July 2021, the coronavirus disease 2019 (COVID‐19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three‐stage restructuring process of pre‐endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff.MethodsThe pre‐endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test.ResultsForehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre‐endoscopy screening methods used displayed regional variations in COVID‐19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre‐endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy‐related nosocomial COVID‐19 infections were reported during the pandemic.ConclusionsWe present a three‐stage pre‐endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID‐19 pandemic.

Fostering greener gastroenterology and hepatology practices

Fostering greener gastroenterology and hepatology practices

Before you implement a new technique or technology in your unit: a strategic perspective of endoscopy

Endoscopy has evolved rapidly in the past decades because of significant increases in the number of endoscopy units, development of specific tools and accessories, ease of access (eg, open-access endoscopy), and high-quality prospective data showing good long-term patient-oriented outcomes, cost-effectiveness, and feasibility. Concomitantly, leaders of the scientific community have continuously pushed the envelope and expanded the indications and possibilities of digestive endoscopy. Where therapy is concerned, the development of innovative techniques is driven by a superior risk-to-benefit profile when compared with the more invasive classic approaches (eg, surgery).

Improving and Driving Efficiency in Your Endoscopy Unit in the 21st Century

Operations management deals with processes. Processes are fundamental activities organizations use to complete work and attain goals. For organizations to operate efficiently, all employees must work together to complete the delivery of the service offered. Organizational efficiency is directly related to the successful implementation of its processes. When processes are effective, organizational efficiency follows. Organizational efficiency leads to delivery of services that are valued by patients and payors.

Exploring the use of p53 protein expression as an indicator of oesophageal cancer severity from a high incidence rural area of Africa

The expression of p53 has been associated with the severity of other types of cancer. There is scanty information when it comes to oesophageal cancer. This study aimed to explore the use of p53 protein expression as an indicator of oesophageal cancer severity from a high-risk incidence in the African rural population. Fifty-one patients newly diagnosed with oesophageal cancer were recruited from the endoscopic unit at Nelson Mandela Academic Hospital in Mthatha, South Africa. The serological expression of p53 was measured using the ELISA method and the severity of oesophageal cancer expressed in grade was obtained from the histopathology report from patient's oesophageal biopsies. We found that the expression of p53 was equally distributed among the histological grades of cancer with the value of 2495 pg/mL ± 1736 pg/ mL for lower grades and 2520 ± 1539 pg/mL for higher grades. Furthermore, we found that the level of p53 expression was equally distributed in patients from grade 1, 2, 3, and 4. The expression of p53 protein does not vary according to the histological grade of oesophageal cancer in the given population, therefore may not be helpful as a prognostic factor.

The Safety of the Re-Opening of an Academic Medical Center Outpatient Endoscopy Unit During the COVID-19 Pandemic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has spread globally leading to over 3,700,000 deaths. As COVID-19 cases stabilized, the re-opening of endoscopy centers potentially exposed patients and healthcare workers to viral infection. This study aims to determine risk of COVID-19 exposure among patients undergoing outpatient endoscopies in a tertiary care setting during the COVID-19 pandemic.MethodsPatients undergoing outpatient endoscopy were contacted post-procedure for any new COVID-19 symptoms or COVID-19 test results. Patient experiences and perception of personal safety were also determined.ResultsOf the 1,584 patients who completed elective endoscopy, 996 (62.9%) completed the survey. Two patients were diagnosed with COVID-19 within 14 days of procedure. The majority (99.7%) felt safe during their procedure and apprehension regarding endoscopy decreased over time.ConclusionThus, the risk of COVID-19 transmission during outpatient endoscopy is extremely low when following recommended society guidelines. Patients felt safe during the procedure and experienced less fear of exposure over time.

Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study.

Background and AimsGastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes.MethodsThis was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments.ResultsOverall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386–4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630–2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004–1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033–1.363]; p = 0.015) as associated with appointment non-attendance.ConclusionsFemale patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.

Isolation and Identification of H. pylori among Iraq patients with chronic gastric inflammation

Background: H. pylori is one of the gastrointestinal organisms in which more than half the world's population was infected. The aim of this study was to Isolation, identity, and determine antibiotic susceptibility of H. pylori from samples of the patient (biopsies) using various procedures. Patients and methods: A total of 90(58 males, 32females) patients with different age groups from both genders are involved in this study suffering from dyspeptic symptoms They underwent diagnostic ‘upper’ gastrointestinal (G.I.) endoscopy at “Endoscopy unit of AL- Sadder Teaching Hospital in Baghdad “during the period November 2021 to March 2022. Results: The results showed a relationship between H. pylori infection occurrence and endoscopic ally diagnosed dyspeptic patients; it was recorded that H. pylori was isolated in 30 cases. Antibiotic resistance test for H. pylori isolates showing susceptibility to levofloxacin, clarithromycin, ciprofloxacin, and amoxicillin. Whereas all the tested isolates were appearing resistant to metronidazole, and tetracycline. Conclusion: The results showed a relationship between H. pylori infection occurrence and endoscopic ally diagnosed dyspeptic patients. Culture and antibiotic sensitivity assay for detection of H. pylori are more reliable in biopsies than urease tests. H. pylori isolates were sensitive to levofloxacin, clarithromycin, ciprofloxacin, and amoxicillin.

Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study.

Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of 44.4 ± 6.4 kg/m2. The average age of participants was 33.6 ± 10.4 years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.

Integration of robotic in the reprocessing and transfer of endoscopes

Background and study aims Optimal hygiene is crucial for patients undergoing flexible endoscopy. Reprocessing is currently influenced by manual procedures performed by endoscopy staff. To overcome this limitation, we designed and evaluated the integration of robotic application for an automated endoscope processing pathway. Methods We used an endoscope reprocessing pass through machine with drying cabinet and a Franka Emika Panda robot. The robot was programmed to interact with its environment in a compliant way, guaranteeing desired contact force thresholds and therefore ensuring safety of both robot and medical equipment. Results In an initial phase we tested the robots’ ability to handle a modified tray holding an endoscope as well as certain challenges (correct positioning, connection of tubing, undesired collisions). We added another Panda robot arm resulting in a device featuring two independent manipulators and tested the accuracy of each individual step. We evaluated 50 consecutive processing and transfer procedures, simulating the average daily throughput of an endoscopic unit. The endoscopes were removed in adapted tray using a specially designed lifting device and placed in an endoscope storage and venting cabinet. The mean time for the handling of the scope was 104.2 ± 1.2 seconds and an accuracy of 100 % (0 failures in 50 attempts) was achieved.Conclusions To the best of our knowledge, this is the first description and evaluation of an automated compliant robotic assistance in the processing of endoscopes. Further development could help to overcome shortcomings of the man handled endoscope processing and could lead to reproducible, standardized and certified endoscope processing.

The Geographical Distribution of Gastrointestinal Endoscopy Services Within Government and Faith Based Hospitals in Ghana

Background: Gastrointestinal (GI) endoscopy is generally a very safe and effective diagnostic and interventional modality in the current practice of medicine. To plan a comprehensive equitable gastrointestinal endoscopy service, the geographical distribution of this essential facility needs to be mapped.Methods: This study was a cross sectional situational survey of gastrointestinal endoscopy services within government and faith based health facilities in Ghana. Information on the availability of GI endoscopy services as at December 2016 was obtained by interviewingdoctors from the various regions in Ghana. Five (5) doctors working in different hospitals were interviewed per region.Results: Gastrointestinal (GI) endoscopy service was available in 3 out of the 4 teaching hospitals and only one regional hospital (Sunyani) in Ghana. The upper east, Upper west and Volta regions have no GI endoscopy services within any government or faithbased facility. The Christian Health Association of Ghana (CHAG) complemented government effort with GI endoscopy units at 4 district hospitals located in the Eastern, Central, Brong Ahafo and Volta regions.Conclusion: The distribution of gastrointestinal endoscopy services within government and faith based facilities is uneven. There is an urgent need to establish these services equitably across Ghana.

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.

Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.