Over one million upper endoscopies are performed annually in France. Although no regulation mandates it, single-use (SU) bite blocks remain the standard practice. We evaluated the environmental benefit of switchint to reusable (RU) bite blocks for upper gastrointestinal endoscopy.

Reusable polyoxymethylene (POM) bite blocks (TEC-CARE®, Chavelot, France) combined with rubber bands were tested. Preliminary tests consisted of subjecting the bite blocks to repeated steam sterilization cycles (134°C, 18 min) after real-life patient use.

After confirming their integrity through successive sterilization cycles, a comparison was done between standard SU bite blocks (ALTON-Medical®, China) and the reusable model under several scenarios (with or without reusing the rubber band, disinfection in automated endoscope reprocessors, or steam sterilization). A simplified life cycle assessment focusing exclusively on greenhouse gas emissions (kgCO₂e) was then performed using the CAREBONE™ tool developed by AP-HP (video abstract).

Twenty reusable bite blocks were used over two months. All tolerated at least ten sterilization cycles with no visible degradation impairing their use. However, the rubber bands did not withstand sterilization, requiring continued use of single-use bands due to the lack of suitable reusable alternatives.

Several scenarios were compared, assuming ten uses per RU bite block:

- Single-use bite block + single-use band: 1.05 kgCO₂e

- Reusable bite block (sterilized) + single-use band: 1.25 kgCO₂e

- Reusable bite block (disinfected) + single-use band: 0.62 kgCO₂e

- Reusable bite block (disinfected) + reusable band (hypothetical due to lack of a readily available model): 0.12 kgCO₂e

If reusable bite blocks with reusable bands were implemented nationwide (≈1 million oral procedures/year), emissions avoided would amount to 930 tCO₂e per year, equivalent to 260,000 cheeseburgers or to the carbon footprint of building 20 new detached houses (French Ecological Agency ADEME).

We demonstrated that POM reusable bite blocks withstand repeated sterilization

Sterilizing reusable bite blocks combined with disposable bands does not provide an ecological advantage over single-use devices due to the environmental burden of sterilization. In contrast, disinfection in automated endoscope washer-disinfectors reduces CO₂ emissions by approximately 40%. These findings led to a change in practice in our department, with the adoption of reusable bite blocks (combined initially with disposable bands) disinfected together with the endoscope after each procedure.

Acknowledgement: POM bite blocks were graciously manufactured and provided for freeby Tec-Care