Aims
In ESGE Days 2025, we reported the first comparative carbon-footprint analysis of four commonly used cold snares. Although relevant for sustainable endoscopy, environmental data alone cannot guide equipment selection. This follow-up study incorporates new elements not previously presented: (1) a functional evaluation based on standardized mechanical performance as a surrogate of clinical efficacy, and (2) a composite sustainability scoring system integrating environmental impact, mechanical performance, and cost.
Methods
Four 10-mm cold snares (mdd GmbH, Olympus SnareMaster Plus™, Boston Scientific Captivator™ Cold, Steris Exacto®) underwent standardized functional testing on biological tissue (n=40), including dimensional accuracy and average traction force measured using a calibrated dynamometer. For analysis, snares were randomly assigned codes A–D to avoid brand bias. Environmental impact (kgCO₂e) was extracted from life-cycle inventory data, and price (EUR) was recorded for each device. A multi-criteria scoring system (MCDA) was constructed using min–max normalization and three weighting scenarios aligned with public procurement practice in Spain: 100:0:0, 50:30:20, and 33:33:33 (price–environment–ergonomics). Lower scores indicate a more sustainable device. Given the inherent uncertainty of LCA modelling, the need for Montecarlo simulation to generate 95% uncertainty intervals is acknowledged.
Results
Dimensional accuracy was consistent (9.10–10.48 mm). Average traction force varied from 2.52 N (A) to 4.10 N (C), indicating poorer ergonomic performance for C. Environmental impact ranged from 0.324 to 0.609 kgCO₂e. Composite results using the corrected dataset demonstrated stable rankings across all weighting schemes, consistently identifying snare A as the most favourable, followed by C, B and D.
Table. Raw data and composite scores (A–D coding)
|
Snare |
Euros |
kgCO₂e |
Avg Force (N) |
Score 50:30:20 |
Score 33:33:33 |
Score 100:0:0 |
|---|---|---|---|---|---|---|
|
A |
11.5 |
0.445 |
2.52 |
6.39 |
14.46 |
11.50 |
|
B |
19.4 |
0.609 |
2.77 |
10.44 |
22.78 |
19.40 |
|
C |
14.0 |
0.388 |
4.10 |
7.94 |
18.49 |
14.00 |
|
D |
21.2 |
0.324 |
2.54 |
11.21 |
24.06 |
21.20 |
Conclusions
This work provides the first integrated environmental–mechanical assessment of cold snares. The proposed composite scoring system is transparent, reproducible and aligned with current European and Spanish procurement legislation, supporting the incorporation of environmental and ergonomic criteria into tendering processes. Future studies should incorporate Montecarlo–based uncertainty modelling and clinical outcomes to validate and strengthen this approach.