Dias Blanco, MartaLopes, SílviaMartins, SusanaCunha Neves, João A.2026-02-022026-02-0220250016-5107PURE: 151820453PURE UUID: 8abcb374-2955-4b8d-85bc-1a461a302d58Scopus: 105026387354PubMed: 41223975http://hdl.handle.net/10362/199947Publisher Copyright: © 2025 American Society for Gastrointestinal Endoscopy.Background and Aims Endoscopy represents the third-largest source of hazardous waste in a hospital, driven by reliance on single-use devices, high procedural volumes, and complex waste management requirements. This study aims to compare the carbon footprint, waste-processing costs, and total endoscopic waste generated before and after a sustainability intervention in the endoscopy unit at Santa Maria Hospital, Lisbon, Portugal. Methods We conducted a 3-stage prospective study. Stage 1 (preintervention) involved an internal audit and daily weighing of endoscopic waste over 4 weeks. Stage 2 (intervention) consisted of awareness training focused on waste segregation and recycling promotion. Stage 3 (postintervention) comprised daily weighing of endoscopic waste over a subsequent 4-week period. Pre- and postintervention outcomes—including carbon footprint, waste processing costs, and total endoscopic waste—were compared using paired-sample t tests and Wilcoxon signed-rank tests. For carbon footprint estimation, each kilogram of landfill waste was assumed to correspond to 1 kg CO2e, whereas each kilogram of regulated medical waste was assigned a value of 3 kg CO2e. Results A total of 1058 endoscopic procedures (preintervention, 517, and postintervention, 541) were performed during the study period. The carbon footprint decreased significantly, from 1859.5 kg CO2e to 1334.8 kg CO2e ( P = .004). Waste processing costs were also significantly reduced, from U.S. dollars (USD) 302.1 to USD 208.1 ( P = .004). The total amount of waste generated showed a nonsignificant reduction, from 706.9 kg to 667.8 kg ( P = .539). Conclusions The sustainability intervention demonstrated a meaningful impact, with education and the adoption of sustainable practices—namely waste segregation and recycling—leading to reductions in carbon footprint, waste management costs, and overall waste generation.979509engRadiology Nuclear Medicine and imagingGastroenterologySDG 3 - Good Health and Well-beingSDG 12 - Responsible Consumption and Productionjournal article10.1016/j.gie.2025.10.044https://www.scopus.com/pages/publications/105026387354