Becker's ASC Review

30 GASTROENTEROLOGY Cutting GI's CO2 footprint at no cost to patient care: 8 things to know By Francesca Mathewes R amjohan Rammohan, MD, a gastroenterology fellow at Nassau University Medical Center in East Meadow, N.Y., led a two-phase study of endoscopic procedures performed at the facility over one year and reported its findings at the American College of Gastroenterology's 2024 convention. e study measured the environmental impacts of the procedures before and aer applying specific interventions. Here are eight things to know about the study: 1. e study included 1,367 colonoscopies, 1,338 endoscopies and 39 endoscopic retrograde cholangiopancreatographies at a clinic that averages 53 procedures per week. 2. In the first phase of the study, investigators assessed the carbon output from consumables, energy and transport from June to December 2023. ese categories are "vital" in calculating the carbon footprint and the global warming potential of the center's endoscopy procedures. 3. Dr. Rammohan noted the "challenges in quantifying carbon output included [difficulty] gathering accurate data on consumables and assessing the direct and indirect emissions from energy and transport." 4. Staff were then trained on methods to reduce the environmental impact of endoscopy procedures, which focused on using reusable instruments when possible, implementing more efficient sterilization techniques that used fewer chemical and less energy, correctly separating waste, using sustainable consumables, minimizing plastics, and locally sourcing materials when possible. 5. e second phase of the study ran from January to June 2024. Researchers calculated carbon data and measured the GWP using the Bilan Carbone protocol and data from the U.S. Energy Information Administration. ey calculated annual footprints and paired tests to analyze the difference in pre- and post-training periods. 6. Researchers found that interventions resulted in a significant reduction in carbon emissions from electricity, from 5,760 kilograms to 3,100 kilograms. 7. is collectively reduced the overall carbon footprint from 2,387,708 metric tons to 1,311,308 metric tons of carbon-dioxide equivalent. 8. Dr. Rammohan said that the size and type of center might influence the scalability and impact of such green initiatives. "Targeted interventions that do not compromise patient care but significantly contribute to sustainability are important," Dr. Rammohan said. "e crucial factor is commitment across all staff levels and embedding sustainable practices into routine procedures." n Mortality rates for early- onset CRC on the rise: 8 things to know By Francesca Mathewes T he mortality rate of early-onset colorectal cancer has increased over the last two decades, with those aged 20-44 years experiencing the most pronounced impact, Medscape Medical News reported Oct. 27. The findings come from an analysis of the CDC's National Center for Health Statistics and the Surveillance, Epidemiology and End Results databases. The analysis found that early-onset CRC cases are driven primarily by the 20-44-year-old cohort. The study was presented by Yazan Abboud, MD, internal medicine physician and chair of resident research at Rutgers New Jersey Medical School in Newark, at the 2024 American College of Gastroenterology Annual Scientific Meeting. Here are eight more findings from the study: 1. The researchers collected age-adjusted mortality rates for EO-CRC between 2000 and 2022 from the NCHS database, as well as stage-specific, incidence-based mortality rates between 2004 and 2020 from the SEER 22 database. The researchers divided patients into two cohorts by age, one aged 20-44 years and the other 45-54 years, and by tumor stage, with cohorts for early- and late-stage tumors. They compared the annual percentage change between the two groups and assessed trends for the entire cohort of patients aged 20-54 years. 2. There were 147,026 total deaths in the NCHS database resulting from EO-CRC, 27% of which occurred in those 20-44 years old. 3. Mortality rates decreased between 2000-2005 in all ages included in the study but increased from 2005-2022. 4. Mortality also decreased between 2000-2005 in the 45-54-year-old cohort and increased in subsequent years. 5. There were 4,642 deaths among those with early-stage tumors across all age groups in the SEER 22 database. Mortality among these patients increased in the 45-54 cohort, but the 20-44 cohort saw insufficient numbers to determine this outcome. 6. Researchers observed increased mortality in those with late- stage tumors across all age groups in the SEER 22 database. 7. David Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, told Medscape Medical News the findings indicate a need for more evidence-based means of identifying younger individuals with a high risk for EO-CRC. 8. Dr. Johnson, who was not involved in the study, noted that it could be promising to evaluate whether cancers in the younger cohort were more aggressive biologically or whether younger patients tended to dismiss early signs of symptoms, such as overt bleeding and iron deficiency. n

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