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We thank Drs Fujisawa and Fujikawa for their thoughtful comments, which highlight professional and organisational determinants that complement our data on waste generation.1 2 In our multicentre study, all centres adhered to German staffing recommendations (one endoscopist, one assisting nurse, one sedation nurse). This uniform baseline makes it unlikely that team composition alone explains the observed differences. A key finding of our comparative analysis was the effect of personal protective equipment (PPE) strategy: between two hospital units, the unit using reusable gowns generated fewer than half of PPE waste than the single-use unit; published life-cycle analyses similarly report up to 93% less solid waste and roughly two-thirds lower greenhouse gas emissions for reusable versus disposable gowns.3 These structural effects probably exceed the incremental gains achievable by awareness campaigns or small process changes. They do not, however, obviate the need for evidence-based PPE indications that reconcile infection prevention with sustainability across care settings.