P125 Sustainable endoscopy in hepatology: quantifying the effect of applying BAVENO VII guidelines on the endoscopic carbon footprint a multi-centred regional assessment

<h3>Introduction</h3> With the global move towards net zero, the UK NHS has committed to reduce its carbon footprint by 80% between 2028–2033 and achieve net zero by 2040. Endoscopy is the 3rd greatest contributing department per daily bed occupied [1], therefore re-evaluation of endoscopic indications is an important factor in achieving net zero. The Baveno VII guidelines recommend that compensated cirrhotic patients with Fibroscan scores of less than 20kPa and platelet counts greater than 150 x10⁹ are unlikely to have clinically significant varices [2], thereby negating the need for endoscopic surveillance. By applying these guidelines in conjunction with estimated energy costs from previously published data, we aimed to retrospectively calculate the regional endoscopic carbon footprint generated by potentially avoidable procedures across four NHS trusts in the East of England. <h3>Method</h3> In this retrospective study, data was analysed from four hospitals in the East of England. Patients undergoing primary variceal surveillance between January 2021 and October 2023 were identified and their pre-endoscopy Fibroscan results and platelet counts were assessed against the criteria listed in Baveno VII. Exclusion criteria comprised features of decompensation, previous variceal haemorrhage or portal- or splenic vein thrombosis. We defined Baveno VII non-compliance as having both Fibroscan and platelet data available but not meeting the required cut offs, or only having a platelet count available above 150 x10⁹. Patients with no Fibroscan data and a platelet count less than 150 x10⁹ were demeaned indeterminate. Per procedure use of water, mass and energy costs were estimated using previously published data. <h3>Results</h3> 730 patient records meeting eligibility criteria were analysed. 45% (n=330) of procedures were deemed Baveno non-compliant. Of these 330 patients 38% (n=126) had pre endoscopy Fibroscan and platelet data available but did not fulfil Baveno criteria whilst 62% (n=204) patients underwent endoscopy without Fibroscan and with platelet count above 150x10⁹. During the study dates, these 330 procedures generated approximately 37620L of water and 78kg of plastic waste. This totalled a carbon cost of 1657KgCO2e. <h3>Discussion</h3> The exact carbon cost of a single OGD has yet to be determined, however, our data which is likely to represent a significant underestimate, demonstrates that if extrapolated on a global scale, Baveno VII could be a useful tool in rationalising and ultimately reducing the number of OGDs performed and thereby reducing the carbon footprint generated by endoscopy.