{
  "abstract": "Objectives\n\nThe environmental impact of endoscopic techniques remains poorly defined. We compared procedure-related environmental outcomes between conventional endoscopic mucosal resection (EMR) and underwater EMR (U-EMR) for colorectal lesions.Methods\n\nIn this prospective pilot procedure-based life cycle assessment of the resection phase, 10-25-mm colorectal lesions underwent EMR or U-EMR across three endoscopy units. Outcomes included global warming potential (GWP, kg CO₂-equivalent/procedure), waste, life-cycle water consumption, fossil resource scarcity, and terrestrial acidification. Exploratory GWP per en bloc resection was estimated using pooled randomized-trial and pilot-cohort data.Results\n\nForty-nine procedures were included: 23 EMR and 26 U-EMR. En bloc resection was achieved in 56.5% of EMR and 69.2% of U-EMR, and R0 resection in 52.2% and 69.2%. Mean GWP was significantly lower with U-EMR than EMR (1.92 ± 0.54 vs. 2.42 ± 0.50 kg CO₂-eq; p = 0.002), corresponding to a reduction of 0.50 kg CO₂-eq per procedure and 50 kg CO₂-eq per 100 procedures. U-EMR was associated with lower waste generation (324.0 ± 78.3 vs. 407.3 ± 72.0 g; p < 0.001), water consumption (0.56 ± 0.17 vs. 0.77 ± 0.20 m³; p < 0.001), fossil resource scarcity (0.33 ± 0.10 vs. 0.40 ± 0.09 kg oil-eq; p = 0.007), and terrestrial acidification (0.0052 ± 0.0018 vs. 0.0068 ± 0.0018 kg SO₂-eq; p = 0.003). Findings were consistent across scenario and uncertainty analyses. In the meta-analysis-based model, GWP per en bloc resection was lower with U-EMR than EMR (2.59 vs. 3.51 kg CO₂-eq), corresponding to a 26.3% relative reduction.Conclusions\n\nU-EMR was associated with lower procedure-related environmental burden than conventional EMR, persisting after normalization for en bloc resection.Trial registration\n\nNo. 165/26.",
  "abstract_shown": true,
  "affiliations": [
    "Clinical Medicine and Surgery University of Naples Federico II Naples Italy.",
    "Gastroenterology Unit San Pio Hospital Benevento Italy.",
    "Gastroenterology and Endoscopy Unit Hôpital Edouard Herriot Lyon France.",
    "Gastroenterology Department Unidade Local de Saúde do Algarve - Hospital de Portimão Portimão Portugal.",
    "Gastroenterology and Endoscopy Unit ARNAS Civico Hospital Palermo Italy.",
    "Endoscopy and Gastroenterology Unit Fondazione Istituto San Raffaele G. Giglio di Cefalù Cefalù Italy.",
    "Department of Medicine and Surgery Kore University of Enna Enna Italy.",
    "Gastroenterology Unit Ospedale Umberto I Enna Italy.",
    "Department of Gastroenterology Hospital Universitario de Navarra Pamplona Spain.",
    "Navarrabiomed Biomedical Research Center Universidad Pública de Navarra (UPNA) Pamplona Spain."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Giulio Calabrese"
    },
    {
      "affs": [
        2
      ],
      "name": "Frederic Moll"
    },
    {
      "affs": [
        3
      ],
      "name": "João A Cunha Neves"
    },
    {
      "affs": [
        0,
        4
      ],
      "name": "Livio Bonacci"
    },
    {
      "affs": [
        5
      ],
      "name": "Emanuele Sinagra"
    },
    {
      "affs": [
        0
      ],
      "name": "Fabiana Castiglione"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Marcello Maida"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Eduardo Albéniz-Arbizu"
    },
    {
      "affs": [
        2
      ],
      "name": "Mathieu Pioche"
    },
    {
      "affs": [
        4
      ],
      "name": "Sandro Sferrazza"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c24sx5ckpj1d6.bib",
  "cited_by": 0,
  "doi": "10.1002/deo2.70457",
  "fulltext_url": "https://europepmc.org/articles/PMC13710893",
  "id": "c24sx5ckpj1d6",
  "issns": [
    "2692-4609"
  ],
  "landing_url": "https://europepmc.org/article/MED/42947979",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2305|Environmental Impact and Sustainability"
    ]
  ],
  "openalex": "W7223863212",
  "pdf_url": "https://europepmc.org/articles/PMC13710893?pdf=render",
  "pmcid": "PMC13710893",
  "pmid": "42947979",
  "published": "2026-10-26",
  "publisher": "Wiley",
  "ris": "https://research.draconitic.com/paper/c24sx5ckpj1d6.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42947979",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42947979"
    },
    {
      "first_seen": "2026-10-31T12:21:46Z",
      "native_id": "PMC13710893",
      "source": "pmc",
      "url": "https://doi.org/10.1002/deo2.70457"
    }
  ],
  "subjects": [
    {
      "field": "earth",
      "origin": "openalex:2305|Environmental Impact and Sustainability",
      "subfield": "environmental-science"
    }
  ],
  "title": "Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates.",
  "title_text": "Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:46Z",
  "url": "https://research.draconitic.com/paper/c24sx5ckpj1d6",
  "venue": "DEN open",
  "versions": []
}