Carbon footprint and cost reduction by endoscopic grading of gastric intestinal metaplasia using narrow‐band imaging

• Published in: Journal of gastroenterology and hepatology Vol. 39; no. 5; pp. 942 - 948
• Main Authors: Cho, Jun‐Hyung, Jin, So‐Young, Park, Suyeon
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.05.2024
• Subjects: Adult; Aged; Biopsy; Carbon dioxide; Carbon footprint; Carbon Footprint - economics; Climate change; Cost control; Cost Savings; EGGIM; Endoscopy; Environmental impact; Female; Gasoline; Gastric cancer; Gastroscopy; Gastroscopy - economics; Gastroscopy - methods; Green endoscopy; Greenhouse gases; Humans; Intestine; Male; Medical wastes; Metaplasia; Middle Aged; Narrow Band Imaging - economics; Narrow Band Imaging - methods; Narrow‐band imaging; OLGIM; Prospective Studies; Risk factors; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Green endoscopy; OLGIM; EGGIM; Narrow‐band imaging; Carbon footprint
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.16493

Background and Aim Gastric intestinal metaplasia (GIM) is a high‐risk factor for the development of gastric cancer. Narrow‐band imaging (NBI) enables endoscopic grading of GIM (EGGIM). In the era of climate change, gastrointestinal endoscopists are expected to reduce greenhouse gas emissions and medical waste. Based on the diagnostic performance of NBI endoscopy, this study measured the environmental impact and reduced cost of implementing EGGIM during gastroscopy. Methods Using NBI endoscopy in 242 patients, EGGIM classification and operative link on GIM (OLGIM) staging were prospectively performed in five different areas (lesser and greater curvatures of the corpus and antrum, and the incisura angularis). We estimated the environmental impact and cost reduction of the biopsy procedures and pathological processing if EGGIM were used instead of OLGIM. Results The diagnostic accuracy of NBI endoscopy for GIM was 93.0–97.1% depending on the gastric area. When a high EGGIM score ≥ 5 was the cut‐off value for predicting OLGIM stages III–IV, the area under the curve was 0.862, sensitivity was 81.9%, and specificity was 90.4%. The reduction in the carbon footprint by EGGIM was −0.4059 kg carbon dioxide equivalents per patient, equivalent to 1 mile driven by a gasoline‐powered car. The cost savings were calculated to be $47.36 per patient. Conclusions EGGIM is a reliable method for identifying high‐risk gastric cancer patients, thereby reducing the carbon footprint and medical costs in endoscopy practice.