Towards more sustainable endoscopy and lower environmental impact

Healthcare aims to improve health, but also contributes substantially to waste, pollution and carbon emissions. In the Netherlands, healthcare accounts for around 7% of the national CO₂ footprint, while endoscopy departments are among the largest contributors to hazardous hospital waste. Within the Convergence Health & Technology Sustainable Health Program ZEE, researchers and healthcare professionals from Erasmus MC, TU Delft and Erasmus University Rotterdam work together to reduce the ecological footprint of endoscopy care through practical and evidence-based approaches. The program combines expertise in gastroenterology, sustainability, industrial design, procurement and healthcare systems to support more sustainable healthcare practice.

What Zero Emission Endoscopy works on

ZEE studies sustainability across the full endoscopy ecosystem, including procurement, logistics, care pathways, product design, waste streams and implementation in clinical practice. The program combines environmental analyses with practical implementation research to understand where meaningful reductions in waste and emissions can be achieved.

Researchers work together with healthcare professionals, hospitals, suppliers and other stakeholders to explore how sustainable alternatives can be integrated into daily workflows without compromising quality or safety of care. The program also studies broader healthcare system questions surrounding sustainability transition, including procurement chains, reuse strategies, triage procedures and organizational change. One important idea within the program is that “the most sustainable care is care that does not have to be delivered,” for example by improving indications and reducing unnecessary procedures. Implementation and scalability are important parts of the program. Regional hospitals, healthcare professionals and industry partners are actively involved to help ensure interventions remain practical and applicable in daily care.

Featured Story

New ZEE video highlights sustainable endoscopy in practice

A new video from the Zero Emission Endoscopy consortium shows practical interventions currently being implemented at Erasmus MC to reduce the environmental impact of endoscopy care from reducing single-use plastics and medication waste to improving waste separation and lowering energy consumption. Developed together with the Erasmus MC endoscopy green team, the video highlights how small changes in daily practice can collectively contribute to more sustainable healthcare without compromising quality of care. Watch the video.

Policy & societal impact

ZEE contributes to the broader transition towards sustainable healthcare and lower environmental impact within hospitals. The program aligns with national sustainability ambitions such as the Green Deal Duurzame Zorg and climate goals for healthcare.

Several implementation trajectories focus on reducing both CO2 footprint and waste streams in endoscopy departments. Current projects explore how measurable reductions including ambitions around 20% CO2 reduction and 20% waste reduction compared to baseline measurements can be achieved through changes in procurement, product use and clinical workflows. A major challenge and opportunity lies in redesigning the broader healthcare ecosystem surrounding endoscopy care. ZEE therefore develops evidence-based and scalable transition models that may also support sustainability efforts in other healthcare departments and hospitals.

Through scientific publications, conferences, collaborations and stakeholder engagement, the program also contributes to national and international discussions on sustainable healthcare and environmentally responsible innovation.

Partners & ecosystem

The programme collaborates closely with regional hospitals, healthcare professionals, suppliers and healthcare organizations to support practical implementation and co-creation of sustainable interventions in endoscopy care. Participating hospitals include Franciscus Gasthuis, Maasstad Ziekenhuis, Reinier de Graaf, Amphia, HagaZiekenhuis, Bravis and others. Industry collaborations include partnerships with organizations such as Boston Scientific, Pentax Medical, Cook Medical and Meditec to explore sustainable products, procurement strategies and circular healthcare approaches. Healthcare professionals, green teams and regional gastroenterologists are actively involved in co-creation and evaluation activities to ensure solutions remain grounded in daily clinical practice.

Education & talent development

ZEE actively involves bachelor, master and PhD students in interdisciplinary sustainability research and healthcare innovation projects. Students work together with clinicians, designers, engineers and healthcare organizations on real-world sustainability challenges within clinical practice. The program contributes to education and training in sustainable healthcare, circular healthcare systems and implementation science, while also helping build a broader community around environmentally sustainable healthcare.

Looking ahead

In the coming years, ZEE will continue focusing on implementation, validation and scaling of sustainable interventions within endoscopy care pathways.

Ongoing work includes material flow analyses, environmental assessments, circular redesign of products and procedures, supplier collaborations and evaluation of waste and CO2 reduction strategies in clinical practice. Recent projects include a detailed Material Flow Analysis of colonoscopy procedures, a circular redesign of biopsy forceps and regional inventories of more than 80 green practices across participating hospitals. The program is also expanding collaborations with hospitals, suppliers and healthcare stakeholders to further develop scalable and evidence-based transition models for sustainable healthcare practice. Future work will continue to focus on balancing sustainability, feasibility, patient safety and implementation in real-world clinical environments.