Colon capsule endoscopy is not yet green: patient-travel carbon costs of CCE versus colonoscopy in rural Scotland

Objective Colorectal cancer is a leading cause of cancer death in the UK, with colonoscopy as the gold standard test used for diagnosis. However, colonoscopy is resource-intensive and environmentally impactful. Colon capsule endoscopy (CCE) offers a non-invasive alternative, potentially reducing environmental burdens by reducing the need for sedation, non-reusable plastics and patient travel. CCE’s sustainability remains underevaluated but could dramatically reduce carbon emissions. This study aimed to compare the carbon impact of patient travel for CCE compared with colonoscopy in a rural health board. Methods Prospectively collected data were analysed from 233 CCE and 234 colonoscopy patients, respectively, from a single rural health board between May and September 2023. Distances travelled for procedures were calculated using Google Maps, considering standard petrol car emissions. Hypothetical scenarios were examined to model a reduction in travel for patients undergoing CCE, considering postal delivery and returns of equipment. Statistical analysis with Mann-Whitney tests compared travel distances and carbon emissions between cohorts. Results Currently in a rural health board, patients undergoing CCE travel more than those who have a colonoscopy. Of the former, over half require follow-up investigations. By introducing a transport delivery service for CCE and its equipment, patient travel distance is reduced but not enough to have a statistically significant effect. Conclusion The current CCE pathway in a rural health board results in greater carbon production, caused by travel, compared with colonoscopy. The requirement for follow-up procedures results in considerably higher travel distances. To introduce CCE as a less environmentally impactful investigation in the gastrointestinal diagnostics pathway, a reduction in follow-up procedures and therefore less patient travel is imperative. A scenario using transport delivery services allowing at-home diagnostics goes some way to negate this.