Clinical Endoscopy

Current status and trends of green endoscopy: Kihyun Ryu, Won Jae Yoon, Sang Hoon Kim, Da Hee Park, Jin Hwa Park, Ki Bae Bang, Tae Joo Jeon, Da Hyun Jung, Young Sin Cho; Clin Endosc 2025;58(4):493-502. Published online May 21, 2025; DOI: https://doi.org/10.5946/ce.2024.332

The increasing global emphasis on sustainability has extended its influence to the field of medicine, including endoscopy. Green endoscopy aims to minimize the environmental footprint of endoscopic practices while maintaining high standards of patient care. This review examines the current status of green endoscopy, focusing on its environmental impact, strategies for waste reduction, and adoption of sustainable practices. The key topics include the environmental challenges posed by single-use devices, the role of sterilization and recycling, and innovations in energy-efficient endoscopic equipment. Furthermore, we highlight policy recommendations and actionable strategies for healthcare systems to transition toward green practices. By integrating these approaches, the field of endoscopy can meaningfully contribute to global sustainability efforts without compromising clinical outcomes.

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Systematic Review: Ultrasound Goes Echo—Decarbonising Inflammatory Bowel Disease Care Through Intestinal Ultrasound
Sara Massironi, Alessandra Zilli, Federica Furfaro, Mariangela Allocca, Laurent Peyrin‐Biroulet, Vipul Jairath, Silvio Danese
Alimentary Pharmacology & Therapeutics.2025; 62(10): 966. CrossRef

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Awareness of green endoscopy is low among healthcare professionals performing gastrointestinal endoscopy: Tae Joo Jeon, Jae Myung Cha; Clin Endosc 2024;57(6):836-838. Published online July 25, 2024; DOI: https://doi.org/10.5946/ce.2024.004

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Workforce Perception and Awareness of Sustainability in Gastrointestinal Endoscopy: A Systematic Review of Green Endoscopy
Hareesha Rishab Bharadwaj, Syed Hasham Ali, Thai Hau Koo, Aditya Gaur, Balamrit Singh Sokhal, Hassam Ali, Arkadeep Dhali, Fariha Hassan, Saqr Alsakarneh, Omar Al Ta'ani, Sneh Sonaiya, Sheza Malik, Dushyant Singh Dahiya
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Towards Environmentally Sustainable Gastrointestinal Endoscopy
Ji Hyun Kim, Sung Chul Park
Gut and Liver.2025; 19(1): 1. CrossRef
Measuring Medical Waste from Gastrointestinal Endoscopies in South Korea to Estimate Their Carbon Footprint
Da Hyun Jung, Hyun Jung Lee, Tae Joo Jeon, Young Sin Cho, Bo Ra Kang, Nae Sun Youn, Jae Myung Cha
Gut and Liver.2025; 19(1): 43. CrossRef
Green Endoscopy: A Review of Global Perspectives on Environmental Sustainability of Gastrointestinal Endoscopy
Adishwar Rao, Abdullah Sultany, Amlish Gondal, Raja Chandra Chakinala, Hareesha Rishab Bharadwaj, Saurabh Chandan, Hassam Ali, Sheza Malik, Saqr Alsakarneh, Dushyant Singh Dahiya
Journal of Clinical Medicine.2025; 14(11): 3936. CrossRef
Current status and trends of green endoscopy
Kihyun Ryu, Won Jae Yoon, Sang Hoon Kim, Da Hee Park, Jin Hwa Park, Ki Bae Bang, Tae Joo Jeon, Da Hyun Jung, Young Sin Cho
Clinical Endoscopy.2025; 58(4): 493. CrossRef

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Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology: Ji Young Park, Tae Joo Jeon; Clin Endosc 2019;52(2):168-174. Published online January 9, 2019; DOI: https://doi.org/10.5946/ce.2018.105

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Background
/Aims: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases.
Methods
We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical or suspicious cells on brush cytology were identified.
Results
Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802– 15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909; 95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR, 4.318; 95% CI, 1.512–12.262).
Conclusions
Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.

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Risk of Malignancy for Indeterminate Cytology of Bile Duct Strictures: A Systematic Review and Meta-analysis
Kayla R. Lieb, Zachary E. Williams, Harlan Sayles, Muizz Zaman, Mashaal Dhir
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Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
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Journal of the Canadian Association of Gastroenterology.2022; 5(5): 234. CrossRef
Digital Image Analysis has an Additive Beneficial Role to Conventional Cytology in Diagnosing the Nature of Biliary Ducts Stricture
Ahmed Helmy, Heba Mohamed Saad Eldien, Gehan Sayed Seifeldein, Ahmed Mohammed Abu-Elfatth, Adnan Ahmed Mohammed
Journal of Clinical and Experimental Hepatology.2021; 11(2): 209. CrossRef
Predicting Malignancy of Biliary Stricture with a Nomogram in Patients with a Non-Malignant Endoscopic Tissue Diagnosis: A Retrospective Study
Yizhen Zhang, Qingwei Jiang, Qiang Wang, Yunlu Feng, Dongsheng Wu, Tao Guo, Shengyu Zhang, Xi Chen, Yingyun Yang, Wen Shi, Xi Wu, Aiming Yang
Cancer Management and Research.2021; Volume 13: 7735. CrossRef
Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review
Giovanna Del Vecchio Blanco, Michelangela Mossa, Edoardo Troncone, Renato Argirò, Andrea Anderloni, Alessandro Repici, Omero Alessandro Paoluzi, Giovanni Monteleone
World Journal of Gastrointestinal Endoscopy.2021; 13(10): 473. CrossRef
How Can We Differentiate Malignant Biliary Strictures from Clinically Indeterminate Biliary Strictures?
Eui Joo Kim, Jae Hee Cho
Clinical Endoscopy.2019; 52(2): 95. CrossRef

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