{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:27:03Z","timestamp":1783945623282,"version":"3.55.0"},"reference-count":23,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/501100001923","name":"Health Services Research Programme","doi-asserted-by":"publisher","award":["Clinical Lecturers grant (CL-2021-04-002)"],"award-info":[{"award-number":["Clinical Lecturers grant (CL-2021-04-002)"]}],"id":[{"id":"10.13039\/501100001923","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2023,9,4]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Recent evidence suggests that adult patients with IgA tissue transglutaminase levels of \u226510\u00d7 the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy. We aimed to evaluate the cost-benefits and the environmental impact of implementing the no-biopsy approach for diagnosing coeliac disease in clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>We calculated the overall direct and indirect costs of the conventional serology-biopsy approach and the no-biopsy approach for the diagnosis of coeliac disease based on the national average unit costs and the Office of National Statistics data. We further estimated the environmental impact of avoiding endoscopy based on the estimated greenhouse gas emissions from endoscopy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Approximately 3000 endoscopies for suspected coeliac disease could be avoided each year in the UK. Implementing the no-biopsy approach for the diagnosis of coeliac disease in adults could save the National Health Service over \u00a32.5\u2009million in direct and indirect costs per annum and reduce endoscopy carbon footprint by 87 tonnes of CO<jats:sub>2<\/jats:sub> per year, equivalent to greenhouse gas emissions from driving 222\u2009875 miles, carbon emissions from charging over 10\u2009million smartphones and the carbon sequestrated by 1438 trees grown for 10 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The implementation of this non-invasive green approach could be an essential first step in the \u2018Reduce\u2019 strategy advocated by the British Society of Gastroenterology and other international endoscopy societies for sustainable endoscopy practice.<\/jats:p>\n               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