HAO-YU WUHsu, Wen-FengWen-FengHsuChang, Li-ChunLi-ChunChangChang, Wei-YuanWei-YuanChangLin, Hsuan-HoHsuan-HoLinKuo, Chen-YaChen-YaKuoWu, Ming-ShiangMing-ShiangWuChiu, Han-MoHan-MoChiu2026-04-242026-04-242026-02https://scholars.lib.ntu.edu.tw/handle/123456789/737564Colonoscopy significantly impacts healthcare's carbon footprint, and although cold snare polypectomy (CSP) offers a safer, more efficient method for small polyp removal, its environmental impact remains unclear. This study compares carbon footprints between the forceps plus hot snare polypectomy (HSP) versus the universal CSP strategy for subcentimetric polyps.This retrospective analysis compared two distinct polypectomy strategies: forceps plus HSP, involving biopsy removal for diminutive adenomas and HSP for small adenomas, and universal CSP for adenomas smaller than 10 mm. A life cycle assessment evaluated the environmental impacts of endoscopy procedures, with parameters obtained from our previous pragmatic trial and empirical hospital data in 2022. Sensitivity analyses were conducted to assess the robustness of greenhouse gas (GHG) emissions estimates.The universal CSP strategy generated 22.08 kg of carbon dioxide equivalents (COe) per colonoscopy, a 5.30% (95% CI 4.71%-5.89%) reduction compared with 23.32 kg COe for the forceps plus HSP strategy. Based on 15,177 colonoscopies performed in 2022, including 5599 polypectomies, transitioning to universal CSP would reduce an institution's annual GHG emissions by an estimated 6915 kg COe.Adopting a universal CSP strategy for subcentimetric polyps offers a significant environmental benefit alongside established clinical advantages. This single transition could cut procedural emissions by over 5% and substantially reduce the annual carbon footprint of endoscopy units, equivalent to the emissions from over 19,700 miles of passenger car travel. Our findings establish CSP as a key strategy for promoting sustainable healthcare.encarbon footprintcold snare polypectomyhealthcare sustainabilityjournal article10.1111/den.7012541705285