Healthcare systems, especially digestive endoscopy (DE) procedures, add significantly to climate change. Data on environmental awareness within DE units, especially in the Middle East remain limited. This study aimed to assess DE healthcare professionals’ knowledge of climate-change concepts, understanding of environmental sustainability in endoscopy, and attitudes toward green-endoscopy practices in the Middle East.

From July 2025 to October 2025, a cross-sectional study was conducted. An electronic survey (Qualtrics) was distributed to endoscopists, nurses, technicians, and trainees across 11 Middle Eastern countries. The questionnaire evaluated climate-change knowledge, environmental awareness within healthcare, understanding of green-endoscopy principles (13 questions), as well as beliefs and attitudes toward sustainability practices (17 questions). Another section of the questionnaire was on participants’ demographic and work data (12 questions). Descriptive statistics and mean-rank data were used for analysis.

130 participants completed the survey: endoscopists 72 (55.4%), nurses/technicians 58 (44.6%); male 66 (50.8%), female 64 (49.2%). 77 of 130 (59.2%) respondents correctly defined climate change as long-term shifts in temperature and weather patterns, and 50 (38.5%) attributed it to human activity. Knowledge of greenhouse gases was mixed: 73 (56.2%) answered correctly, while 27 (20.8%) selected gases essential for life and 13 (10%) associated it with ozone depletion. Hospital carbon emissions contributors were frequently misidentified, with 86 (66.2%) selecting waste disposal as the major source. Awareness of endoscopy units’ contribution to hospital waste was limited, as only 55 (42.3%) correctly ranked endoscopy units third, and 40 (30.8%) were unsure. Understanding of carbon footprint was low: 69 (53.1%) equated it as a measure for waste generation, whereas only 31 (23.8%) correctly identified greenhouse-gas emissions. In contrast, recognition of green endoscopy was high 120 (92.3%), although only 77 (59.2%) correctly identified that high-quality curative services are not a pillar of green endoscopy. Knowledge related to water use varied: 54 (41.5%) reported that filtered water is allowed for high-level disinfection, and 80 (61.5%) indicated that potable tap water is not permitted for mucosal irrigation.

Concern about climate change was high (n 116, 89.2%). Most participants acknowledged healthcare’s negative impact on the environment (n 71, 54.6%) but perceived limited institutional action. Most respondents (n 86, 66.2%) perceived single-use endoscopes and accessories as a major contributor to the procedure’s environmental burden. In total, 84 respondents (64.6%) believed that adopting a “reuse” approach could compromise patient safety. The majority (n 92, 70.8%) of respondents believed that financial models tied to procedural volume hinder the adoption of environmentally sustainable practices in endoscopy. There was strong support for mandatory training on waste management (n 115, 88.5%), minimizing patient visits when feasible (n 103, 79.2%), and integrating environmental criteria into purchasing decisions (n 101, 77.7%). Almost all respondents expressed interest in further education on sustainable endoscopy (n 123, 94.6%).

Healthcare professionals across Middle Eastern endoscopy units demonstrated strong concern for climate change and high support for sustainable practices. However, substantial knowledge gaps existed regarding greenhouse gases, carbon footprints, hospital carbon emission sources, and endoscopy-related environmental impact. Moreover, institutional supportive actions were limited. Present data provide guidance to develop focused, tailored educational programs, clear protocols, and practical policies to help endoscopy teams implement greener, more environmentally responsible practices in the Middle East.