Introduction A significant amount of plastic is being used in endoscopy. We believed that plastic polypropylene water bottles for the transport of sterile water generates significant amount of plastic/cost and strategies need to be employed to reduce its use. In this study, we aimed to assess the amount of plastic generated by 1L single-use polypropylene water bottles in a year for a number of endoscopic procedures.

Methods Data was obtained from the Endoscopy Database (Unisoft) regarding the number/type of procedures performed throughout 2019. We prospectively assessed the volume of sterile water used for a dedicated endoscopy list: oesophagogastroscopy (OGD), sigmoidoscopy and colonoscopy. For each type of procedure, the volume of sterile water/plastic was estimated for a minimum of 20 procedures. The weight of plastic was measured using a Salter-Arc Electronic scale after leaving the bottle to dry for 48 hrs.

Results In our endoscopy unit, we estimated that we used 336 ml of sterile water per gastroscopy (7.05L for 21 OGDs); 241 ml per sigmoidoscopy (5.3L for 24 sigmoidoscopies); and 782 ml per colonoscopy (17.2L for 22 colonoscopies). For 2019, we performed 4436 OGDs, 2251 sigmoidoscopies and 3135 colonoscopies, which equates to a total estimated volume of sterile water of 4,485L (1490.5L for OGD; 542.49L for sigmoidoscopy; 2451.57L for colonoscopy). The dry weight of a single-use 1L plastic water bottle was 65 g while the cost of 1L of sterile water was 80p. Hence, the amount of plastic generated from water bottles in a year was approximated to 96.92 kg for OGD (21.85 g per OGD); 35.30 kg for sigmoidoscopy (15.68 g per sigmoidoscopy); and 159.38 kg for colonoscopy (50.84 g per colonoscopy). In 1 year, the total plastic generated from sterile water bottles alone for these procedures was 291.6 kg. The total cost for sterile water was £3588.80 (£1192.80 for OGD, £434.40 for sigmoidoscopy and £1961.60 for colonoscopy).

Conclusion We conclude that significantly large volumes of sterile water and single use plastic are being used in endoscopy. This practice is not only costly but also has a detrimental impact on the environment due to the large amount of plastic generated. Reduction of single use plastic needs to be a priority for a greener and more sustainable practice of endoscopy.