Endoscopic procedures are the cornerstone of intervention in gastroenterology—from evaluating common illnesses to non-surgically managing complex diseases. Expectedly, these procedures are linked to greenhouse gas (GHG) emissions globally and contribute significantly to the global climate change crisis. Professional gastroenterology societies globally raise awareness of this evolving crisis and suggest specific measures to appropriately measure the burden contributed by endoscopy units and mitigate the environmental impact of this common clinical practice. To the unsuspecting eye, the solution to this crisis is relatively simple: decrease the utilization of endoscopic procedures. However, the dependence of modern medicine on these procedures, both diagnostically and therapeutically, makes it significantly more challenging to reduce their utilization. Instead, a structured approach to systematically consider the specific indications for each procedure, minimize waste generation, promote recycling of waste products, and limit the number of repeat endoscopies until clinically necessary may be more pragmatic to reduce GHG emissions globally. In this narrative review, we discuss the perspectives of global gastroenterology societies on sustainable or “green” endoscopy and summarize their recommendations to aid the day-to-day gastroenterologist in making their contribution to environmental sustainability while providing optimal care to their patients.

Upadacitinib, a selective Janus kinase-1 inhibitor, is increasingly used for moderate to severe ulcerative colitis, though concerns regarding thrombotic risk persist. We report a rare case of multifocal ischemic stroke in a young patient with ulcerative colitis who developed acute neurologic symptoms approximately 3 months after starting upadacitinib. Neuroimaging revealed extensive bilateral cerebral and cerebellar infarcts without evidence of large-vessel disease, cardio embolism, or inherited thrombophilia. The patient lacked traditional cerebrovascular risk factors and subsequently developed a pulmonary embolism during hospitalization. This case highlights a potential severe thrombotic complication associated with upadacitinib and underscores the need for careful risk assessment and postmarketing surveillance.