Background and objectives:
Waste is a relevant contributor of environmental pollution, as besides the direct consequences of landscape and water pollution, large amounts of greenhouse gases are produced during incineration.
The aim of the present study was to obtain a picture of the amount of waste generated and its composition during endoscopic examinations in order to be able to calculate the recycling potential for Germany's gastrointestinal endoscopy landscape.
To the best of our knowledge, this is the first study worldwide including the amount of waste generated in the office-based sector.

Material and methods:
Over a period of four weeks each, the collection and systematic recording of waste in the endoscopy units was carried out at four centres [Klinikum der Goethe-Universität Frankfurt (KGU), Klinikum Hanau (KSH), Internistische Praxisgemeinschaft Hanau (IPG), Magen-Darm-Zentrum Darmstadt (MDZ)]. After the collection, the waste was classified into the individual components residual waste, accessories (forceps, snares, and so on), personal protective equipment (gloves, disposable gowns, mouth protection), plastics and paper. If the last mentioned had patient contact or were contaminated by patient secretions, they were assigned to the residual waste category. The collected waste was then weighed. Waste from the recovery room and the reprocessing room was also recorded. Waste from the staff break rooms was not included in the analysis.

Results:
In the present study, a total of 2359 examinations were carried out (outpatient offices: 1485; hospitals: 874). In the four weeks, a total amount of waste of 2.70 tons was generated. On average, 1.15 kg of waste was generated per examination (hospitals: 1.23 kg; outpatient offices: 1.10 kg). The amount of waste consisted of 800.0 g residual waste (69.9 %), 52.4 g accessories (4.6 %), 91.4 g personal protective equipment (8.0 %), 114.3 g plastic (10.0 %) and 85.0 g paper (7.5 %).

Conclusions:
To the best of our knowledge, this is the first study worldwide dedicated to the amount of waste generated in the office-based sector. At 1.15 kg, the amount of waste generated per examination in German endoscopy units is more than half as few as in the only fully published study from the USA to date, at 2.4 kg.¹
Although the recycling potential per examination is low at 10% plastic and 7.5% paper, it can make a relevant contribution to reducing the amount of residual waste. In the study period, the amount of reusable waste in the four endoscopy units would be 6.1 tons per year.

1. Namburar S, von Renteln D, Damianos J, et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022;71:1326-1331.

Stefan Zeuzem

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