The study by López-Muñoz et al. published in this issue of Endoscopy provides a critical analysis of the carbon footprint associated with single-use duodenoscopes (SUDs) and reusable duodenoscopes (RUDs), offering valuable insights into the broader environmental impact of medical equipment [1]. By modeling three distinct clinical scenarios, the authors highlight the substantial difference in carbon emissions between the approaches, emphasizing particularly the environmental benefits of reusable devices; however, the study also brings to light an often underestimated aspect of environmental impact in healthcare: Scope 3 emissions.

Scope 3 emissions refer to the indirect emissions that occur throughout a product's value chain, including those generated during the production, transportation, and disposal of medical equipment. Unlike Scope 1 and 2 emissions, which are directly tied to healthcare facilities and their energy consumption, Scope 3 emissions encompass the full lifecycle of the equipment used, making them more challenging to measure, and meaning they often overlooked in environmental assessments. While Scope 1 and 2 emissions are relatively straightforward to measure and report, Scope 3 emissions are more complex, leading companies often to rely on industry averages in their estimates.

Yet, the significance of these findings extends beyond the specific context of duodenoscopes. They prompt a broader reflection on the healthcare industry’s approach to environmental sustainability. The overwhelming focus on direct emissions and operational efficiency has led to an underestimation of the true environmental impact of medical devices. When an endoscopy company advertises its commitment to sustainability, it often emphasizes grand visions of solar power and recycling. Should we be impressed? Not necessarily. The elephant in the room is the carbon emissions from the value chain. In fact, 82% of healthcare emissions come from the supply chain of medical devices [2].

What was not highlighted in the study by López-Muñoz et al. is the significant contribution of electronic components (e.g. semiconductors, wires, etc.), which are typically manufactured by suppliers and then assembled into each SUD at a local plant. These components require substantial amounts of energy and water to manufacture, are often transported across continents, and are challenging to recycle after use. It is no surprise that electronic components account for most of the emissions from an SUD [3]. Recycling itself is tricky; in many countries, there is no third-party accountability for best practices and, in certain instances, recycling electronic components can emit more pollution than producing new ones [4].

By neglecting Scope 3 emissions, we risk overlooking substantial sources of carbon output, thereby undermining efforts to achieve meaningful reductions in the healthcare sectorʼs overall carbon footprint. Addressing this requires a more comprehensive approach to environmental assessments – one that integrates material composition, manufacturing processes, transportation [5], and disposal practices [6]. We look forward to more robust accounting methods, such as using primary data for Scope 3 emissions rather than relying on estimates from industry standards, as currently allowed by the Greenhouse Gas Protocol. Another step forward would be to assign emissions to each medical device, rather than to the entire company.

It was not long ago that we prioritized two factors when deciding which product to use: cost and performance. Now, environmental impact is becoming the third product differentiator for device procurement. Although these suggestions may sound aspirational, they are backed by sound accounting principles [7] and are slowly gaining the attention of companies. The first step is to start engaging with device companies in a spirit of mutual learning and collaboration. Endoscopists, as well as patients, deserve to see these granular data in the public domain to make informed decisions about which products to use.

In conclusion, the study by López-Muñoz et al. challenges us to look beyond the immediate visible impacts of our practices and consider the broader, often hidden, environmental costs. By recognizing and addressing Scope 3 emissions, we can take a significant step toward a more sustainable and environmentally responsible healthcare system.

Article published online:
05 November 2024

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