Endoscopy units are the third largest emitters of carbon dioxide (CO₂) within hospitals. A substantial part of these emissions results from waste. Improving waste segregation and reducing waste in endoscopy units requires detailed insights into current waste streams. We aimed to quantify waste generation in an academic endoscopy department and to estimate the associated carbon footprint. 

We performed a five-day waste audit of the pre-, post- and procedure phases of an eight-room gastrointestinal endoscopy department. Waste from the reprocessing area was excluded. All waste streams were collected twice daily and subsequently weighed and categorized into preidentified waste streams. The total mass (kg) per waste stream and per procedure was calculated. Procedure numbers during the study period were recorded, and waste-related carbon emissions (carbon dioxide equivalents (CO₂e)) were estimated using national carbon emissions factors. 

Over the five-day period, 243 endoscopic procedures were performed: 64 colonoscopies, 107 esophagogastroduodenoscopies, 13 endoscopic retrograde cholangiopancreatographies, 31 endosonographies, and one video capsule endoscopy. In addition, 27 procedures were pulmonary endoscopies. Given that gastrointestinal endoscopy constituted nearly 90% of activity during the audit, these findings mainly reflect waste patterns in gastrointestinal endoscopy workflows. On average, 49 procedures were performed per day (range 44-54). A total of 317.6 kg of waste was generated. Most waste consisted of general waste (184.9 kg, 58%), followed by hazardous waste including sharps (78.6 kg, 27%), and recycled materials (47.5 kg, 15%). Each procedure generated approximately 1.3 kg of waste. Waste-related carbon emissions amounted to 1,465 kg CO₂e over the 5-day period, corresponding to 6 kg CO₂e per procedure and an estimated 58,820 kg CO₂e annually of endoscopy waste in this center, which is equivalent to driving a conventional car for 266,000 km, or six times around the earth. 

This is the first 5-day comprehensive waste audit of pre-, post- and procedure phases in an endoscopy department in a Dutch academic hospital, providing a baseline for targeted sustainability interventions. It highlights substantial opportunities for waste reduction and segregation, improved recycling, and can guide environmental improvement efforts in endoscopy units.