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Location

University Hospital Würzburg (UKW), Bavaria, Germany 

Initiation date

2023 (Pilot launched mid-2023, intervention period February-May 2023) 

Sector setting

A tertiary-care academic hospital’s Gastroenterology unit providing gastrointestinal endoscopy diagnostics and treatment 

Mitigation initiative

The “Green Endoscopy Project” at University Hospital Würzburg (UKW) is one of Germany’s first targeted interventions to reduce Scope 3 greenhouse gas (GHG) emissions in clinical endoscopy. Initiated in 2023 by the Department of Gastroenterology [1], [2], the project focused on reducing the environmental impact of single-use medical equipment and consumables used in gastrointestinal (GI) procedures. Through a comprehensive audit and intervention approach, the project aimed to shift procurement toward lower-emission alternatives and instil sustainable practices without compromising patient care. The initiative followed a systematic (audit → action →re-audit) cycle to ensure evidence-based actions and enable evaluation and scalability of results. [1] 

A baseline carbon footprint audit of all endoscopy-related consumables (359 products) was conducted. Following this, structured questionnaires were sent to suppliers to gather data on product origin, manufacturing, packaging and transportation. Based on the findings, 224 items were replaced with lower-emission or locally sourced alternatives, prioritising options with shorter supply chains and reduced packaging. In parallel, clinical staff received training to reduce unnecessary instrument use, which led to a 10% decline in the number of items used per procedure. Operational measures complemented these changes, including the implementation of a new waste segregation and recycling system in the endoscopy suite, as well as a slight reduction in room temperature to minimise heating-related emissions. [1] 

GHG emission reduction measures  

The assessed yearly carbon emissions of the gastrointestinal endoscopy unit were estimated at 62.72 tons of carbon dioxide equivalent before reduction measures, based on a separate annual assessment of unit-level emissions. This annual figure provides useful context for the scale of emissions, while the intervention results reported below refer to the February–May comparison period. (Scope 1: 36 tCO₂e/year, Scope 3: 27 tCO2e/year.) 

Scope 3 - Reducing emissions from heating

Measures included adjusted heating, e.g. endoscopy suite temperature was lowered ~2 °C to save on gas use. [1] [5]

Scope 2

N/A. The hospital was already serviced by 100% renewable electricity (green energy), so operational power use was treated as producing near-zero CO₂ in the reported assessment. 

Scope 3 - Reducing emissions from procurement, usage reduction and waste management

Actions included: 

  • Procurement: 224 of 359 catalogued products were switched to lower-carbon alternatives (mainly by selecting products with shorter transport routes). For example, some items or accessories formerly shipped from Asia were sourced from Europe or Bavaria.  

  • Usage reduction: Staff were taught to avoid overuse of instruments. This yielded a 10% drop in instruments used per procedure , directly cutting material consumption. [1] 

  • Waste management: A recycling system was introduced for endoscopy packaging and consumables. Paper and plastic wrappings were diverted from landfill. (As a result, the residual waste volume for endoscopy procedures fell by ~20%). [1] 

Key learnings

Project leaders faced data gaps and supplier-engagement challenges, with limited transparency from manufacturers representing a major hurdle. Only 26 of 40 vendors replied to the CO₂ questionnaire, and for most items no greener version existed. The team therefore had to calculate footprints in-house by setting up a custom carbon calculator. Hospitals must be prepared to collect and compute data themselves, and to work persistently with vendors. 

 Success also required multidisciplinary collaboration between clinicians, hospital procurement, and waste teams. Project members emphasized that close work with purchasing was essential and that any product swap must not compromise patient care quality. Clear communication and training helped staff accept new routines. Educating the team was also key to reducing instrument use: by demonstrating the environmental impact of excess instruments, staff voluntarily cut usage. This shows that behaviour change is possible with engagement. Moreover, creating a procedure-level carbon-footprint tool was valuable and could be refined for other units. This systematic approach (audit→action→re-audit) proved effective and can guide future projects. 

 Finally, simple actions, such as lowering room temperature or recycling packaging, had measurable effects. Over time, these measures accumulated into meaningful emissions savings. The experience suggests that progress can be achieved through operational and procurement changes, without requiring major capital investment. 

Initiative outcomes

Evidence of Success  

The project yielded an 11.5% reduction in procedure-related Scope 3 emissions. The carbon footprint dropped from 8.01 to 7.09 tons CO₂-equivalent, corresponding to the total Scope 3 emissions associated with all gastrointestinal endoscopy procedures over the February–May 2023 intervention period compared to the same period in 2022. This distinction is important because the percentage reduction relates to procedure-related emissions over the study period, not to the full annual emissions baseline. Including the benefit from better waste sorting (20.1% saving of emissions achieved through improved waste management from recycling), total endoscopy emissions fell 18–19% (from 33.24 to 26.55 tCO₂e in the endoscopy-related emissions category, Scope 1–3 combined). In absolute terms, the UKW GI unit’s estimated CO₂ output (Scopes 1–3) went from ~63 t/yr down to ~52 t/yr after measures. [1] [5] 

 The 10% reduction in instruments used(3111 now, which earlier was 3457 instruments used across all sampled procedures over 3 months) and the smaller waste stream may also have reduced costs through lower purchasing and disposal needs. However, the published study did not quantify financial savings, so any cost implications should be treated as indicative rather than reported outcomes. These operational gains occurred without extending procedure time or staffing. 

Co-benefits 

Beyond emissions, the initiative improved sustainability culture and operational efficiency. Recycling in the endoscopy unit became routine, diverting a significant volume from incineration. Staff awareness also increased and adopted more conscious instrument use. The focus on shorter supply chains enhanced procurement oversight. Importantly, patient care was reported as unaffected, with procedures continuing as normal while lowering the unit’s footprint. Finally, the project earned visibility, and the initiator, Dr. Henniger, received the DGVS Martin-Gülzow Prize in 2024 for climate-friendly gastroenterology research, illustrating professional recognition of the work. [2] [3] [4] 

 

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