Quantification of Medical Waste and Incineration‐Related CO 2 Emissions Associated With Gastrointestinal Endoscopy at Two Facilities in Japan: A Preliminary Observational Study

ABSTRACT Objectives Sustainable development oals in gastrointestinal endoscopy (GIE), referred to as “green endoscopy,” have been a research focus in Western countries. However, the environmental burden of GIE in Japan is poorly understood. We quantify medical waste and estimate GIE‐derived incineration‐related CO 2 emissions in Japan. Methods In a dual‐center observational study, we report waste from esophagogastroduodenoscopy (EGD), colonoscopy (CS), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic submucosal dissection (ESD) from June 2024 to January 2025. We classify waste as infectious/non‐infectious, combustible/non‐combustible, liquid, or sharps. We record the per‐procedure waste and the procedure time, estimate CO 2 emissions from the combustion of the measured waste mass using combustion equations for cellulose and polyethylene, and calculate per‐minute emissions and annual totals. Sensitivity analyses are performed for changes in the anticipated waste composition. Results Estimated per‐procedure CO 2 emissions are 949, 1178, 5834, and 4780 g for EGD, CS, ESD, and ERCP, respectively. Aggregate per‐minute emissions are 168, 165, 89, and 75 g/min for ERCP, EGD, CS, and ESD, respectively. Annual institutional emissions total approximately 5800 kg. Estimated emissions are 64%–69% and 123%–134% of the base composition scenario values in the lower‐ and higher‐emission composition scenarios, respectively. Conclusions ESD had the highest per‐procedure emissions, and ERCP and EGD had the highest per‐minute emissions. These results provide preliminary baseline data on incineration‐derived CO 2 emissions as a foundation for promoting “green endoscopy.”