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Introduction Gastrointestinal (GI) endoscopy services are carbon intensive due to fixed operational requirements including ventilation, estate usage, and staffing, which are deployed for scheduled lists irrespective of patient attendance. 1 2 When patients do not attend (DNA), these fixed emissions are redistributed across fewer completed procedures, increasing carbon intensity per procedure.1 2 We aimed to quantify service capacity loss and associated carbon inefficiency attributable to endoscopy non-attendance across a two-site NHS trust.Methods A retrospective analysis of all elective outpatient endoscopy bookings was conducted over a 12-month period (June 2024–May 2025) across a service operating six endoscopy rooms (three per site) five days per week. DNAs were identified from the endoscopy scheduling system. Capacity loss was expressed as half-day room lists and equivalent full service days. Carbon impact was modelled by allocating conservative fixed operational emissions per scheduled list, reflecting energy and estate activity that persists despite non-attendance. 1 2 Sensitivity analysis (±20%) was applied to account for variation in estate energy use. Carbon estimates were derived from published life-cycle assessments of endoscopy services.1 2Results Among 14,124 booked procedures, 432 resulted in non-attendance, giving a DNA rate of 3.1%. This equated to 73 lost half-day room lists, or approximately six full-service days of capacity. As lists proceeded as scheduled, DNAs were associated with a 3.2% increase in carbon intensity per completed procedure. Sensitivity modelling estimated 0.9–3.5 tonnes of avoidable carbon emissions annually attributable to non-attendance, consistent with reported per-procedure emission ranges in endoscopy services. 1 2Conclusion Even modest rates of non-attendance are associated with clinically significant losses in endoscopy capacity and measurable carbon inefficiency. Interventions targeting DNAs, including booking reminders, short-notice backfilling, and risk-stratified booking, represent pragmatic opportunities to improve access, optimize resource utilization, and provide a framework for managers to work towards the NHS Net Zero agenda. 3 4References Lacroute J, et al. Environmental footprint of gastrointestinal endoscopy services: a systematic review. Endoscopy 2025. DOI:10.1055/a-2739-4080.Lacroute J, et al. The carbon footprint of ambulatory gastrointestinal endoscopy: a multi-criteria analysis. Endosc Int Open 2023;11:E458–E466.NHS England. Delivering a Net Zero NHS. 2020.British Society of Gastroenterology. Sustainability in Endoscopy: BSG Guidance. 2023.