APAGE Position Statements on Green and Sustainability in Gastroenterology, Hepatology, and Gastrointestinal Endoscopy

Ang TL 1 , Hang DV 2 , Li JW 1 , Ho JCL 3 , Sy-Janairo ML 4 , Raja Ali RA 5 Show all authors , Makharia GK 6 , Sundaram S 7 , Chantarojanasiri T 8 , Kim HG 9 , Isayama H 10 , Pausawasdi N 11 , Wu K 12 , Syam AF 13 , Aye TT 14 , Rehman S 15 , Niriella MA 16 , Jurawan R 17 , Wang L 18 , Leung WK 19 , Liou JM 20 , Rizan C 21 , Wu JCY 3 , Ooi CJ 22

Affiliations 

  • 1 Department of Gastroenterology and Hepatology, Changi General Hospital, Duke-NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  • 2 Endoscopy Centre, Hanoi Medical University Hospital, Hanoi, Vietnam
  • 3 Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
  • 4 Institute of Digestive and Liver Diseases, St. Luke's Medical Center-Global City, Taguig, Philippines
  • 5 School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
  • 6 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
  • 7 Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
  • 8 Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
  • 9 Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
  • 10 Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
  • 11 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 12 Fourth Military Medical University, Xijing Hospital, Xian, China
  • 13 Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
  • 14 Department of Gastroenterology, Yangon General Hospital. University of Medicine 1, Yangon, Myanmar
  • 15 Department of Gastroenterology, Khyber Girls Medical College, Hayat Abad Medical Complex, Peshawar, Pakistan
  • 16 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
  • 17 Taranaki Base Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  • 18 Second Affiliated Hospital of Zhejiang, University School of Medicine, Hangzhou, China
  • 19 Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
  • 20 College of Medicine, National Taiwan University, Taipei, Taiwan
  • 21 Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 22 Duke-NUS Medical School, Gleneagles Medical Centre, Singapore
J Gastroenterol Hepatol, 2025 Jan 31.
PMID: 39888113 DOI: 10.1111/jgh.16896

Abstract

BACKGROUND AND AIM: The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.

METHODS: A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.

RESULTS: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.

CONCLUSION: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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