Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates.
10 affiliations
- 1Clinical Medicine and Surgery University of Naples Federico II Naples Italy.
- 2Gastroenterology Unit San Pio Hospital Benevento Italy.
- 3Gastroenterology and Endoscopy Unit Hôpital Edouard Herriot Lyon France.
- 4Gastroenterology Department Unidade Local de Saúde do Algarve - Hospital de Portimão Portimão Portugal.
- 5Gastroenterology and Endoscopy Unit ARNAS Civico Hospital Palermo Italy.
- 6Endoscopy and Gastroenterology Unit Fondazione Istituto San Raffaele G. Giglio di Cefalù Cefalù Italy.
- 7Department of Medicine and Surgery Kore University of Enna Enna Italy.
- 8Gastroenterology Unit Ospedale Umberto I Enna Italy.
- 9Department of Gastroenterology Hospital Universitario de Navarra Pamplona Spain.
- 10Navarrabiomed Biomedical Research Center Universidad Pública de Navarra (UPNA) Pamplona Spain.
Abstract
Objectives
The 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
In 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
Forty-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
U-EMR was associated with lower procedure-related environmental burden than conventional EMR, persisting after normalization for en bloc resection.Trial registration
No. 165/26.
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BibTeX
@article{calabrese2026environmental,
title = {{Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates.}},
author = {Giulio Calabrese and Frederic Moll and João A Cunha Neves and Livio Bonacci and Emanuele Sinagra and Fabiana Castiglione and Marcello Maida and Eduardo Albéniz-Arbizu and Mathieu Pioche and Sandro Sferrazza},
journal = {DEN open},
year = {2026},
month = oct,
doi = {10.1002/deo2.70457},
url = {https://europepmc.org/article/MED/42947979},
note = {CC BY},
}
RIS
TY - JOUR
TI - Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates.
AU - Giulio Calabrese
AU - Frederic Moll
AU - João A Cunha Neves
AU - Livio Bonacci
AU - Emanuele Sinagra
AU - Fabiana Castiglione
AU - Marcello Maida
AU - Eduardo Albéniz-Arbizu
AU - Mathieu Pioche
AU - Sandro Sferrazza
PY - 2026
DA - 2026/10/26
JO - DEN open
DO - 10.1002/deo2.70457
UR - https://europepmc.org/article/MED/42947979
AB - Objectives The 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 In 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 Forty-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 U-EMR was associated with lower procedure-related environmental burden than conventional EMR, persisting after normalization for en bloc resection.Trial registration No. 165/26.
SN - 2692-4609
ER -