Workforce Perception and Awareness of Sustainability in Gastrointestinal Endoscopy: A Systematic Review of Green Endoscopy.

BACKGROUND

Gastrointestinal (GI) endoscopy is a high-throughput, resource-intensive specialty with a substantial environmental impact. As healthcare systems move toward sustainability, the concept of "green endoscopy" (GE) has gained traction. However, the perceptions and engagement of the endoscopy workforce remain underexplored.

OBJECTIVE

This systematic review aimed to evaluate awareness, attitudes, and perceived barriers among healthcare professionals regarding sustainability in endoscopy and to synthesize existing knowledge on workforce engagement with GE practices.

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to April 1, 2025, supplemented by gray literature. Included studies reported original data on healthcare professionals' knowledge, attitudes, or practices related to sustainable endoscopy. Due to heterogeneity, a synthesis without meta-analysis (SWiM) approach was used.

RESULTS

Five cross-sectional studies involving 1684 participants across various regions were included. Awareness of GE ranged from 16.3% to 67%. While most respondents acknowledged the environmental burden of endoscopy, fewer reported institutional guidelines or training. Key barriers included lack of knowledge (35%), absence of institutional policy (32%), infection control concerns (41%), and financial constraints (26%). Few departments conducted audits or offered sustainability education. A generational divide was noted, with senior staff expressing greater environmental concern.

CONCLUSION

Although global interest in sustainable endoscopy is rising, a significant gap exists between awareness and practice. Structured education, clear institutional policies, and support from professional bodies are essential to embed sustainability within endoscopy services.