The case for reducing the use of diagnostic upper and lower gastrointestinal endoscopy

Luminal gastroenterology remains a fascinating and diverse specialty, attracting high numbers of applicants to fellowship posts. One potential reason for this popularity is that it is a practical discipline, due to the introduction of fibreoptic endoscopy in the 1960s, wherein physicians see patients and can investigate their symptoms themselves. However, current evidence suggests many diagnostic endoscopies being done are of low yield, which represents an opportunity to enhance the value of care.1 Low-value diagnostic endoscopy has led to long waiting lists for procedures, a large backlog of cases, exacerbated by the COVID-19 pandemic, and the proposal in recent years that, to clear this backlog and reduce waiting times, training of additional endoscopists is required. In addition, endoscopy has a large carbon footprint. Endoscopy departments are the third-highest generators of hazardous waste in the hospital, and the second-highest generator of total waste.2 In the USA, it is estimated more than 85 000 metric tonnes of carbon dioxide are emitted per year due to endoscopy.2 Combined, we are providing low-value care to the detriment of the environment. Rather than continuing to perform ever increasing numbers of endoscopies, it is worth considering that, over the past 20 years, more judicious use of endoscopy has been implemented in two specific situations.