GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (On-Demand) | February 2026-ASGE_multisociety endoscope reprocessing guideline

ASGE_multisociety endoscope reprocessing guideline

Pdf Summary

This multisociety guideline provides comprehensive, evidence-based recommendations for the reprocessing of flexible gastrointestinal (GI) endoscopes and accessories to ensure patient safety and infection prevention. Flexible GI endoscopy is critical for diagnosing and treating digestive diseases, but endoscopes are complex devices that require meticulous cleaning and reprocessing to prevent exogenous infections transmitted via contaminated equipment.<br /><br />The guideline reviews the Spaulding classification system, categorizing medical devices by infection risk and recommending corresponding levels of disinfection or sterilization. Flexible GI endoscopes are generally semi-critical devices requiring at least high-level disinfection (HLD), though some may be considered critical due to their use in sterile tissues.<br /><br />Key recommendations include strict adherence to manufacturer instructions for precleaning (point of use treatment), manual cleaning (using model-specific brushes), leak testing, automated high-level disinfection via an automated endoscope reprocessor (AER), thorough drying of endoscope channels using forced air, safe storage in specialized cabinets, and regular staff training and competency assessments. Personnel must receive specific training and demonstrate competency before reprocessing endoscopes.<br /><br />Evidence does not support the routine use of repeat HLD cycles or ethylene oxide (EtO) sterilization compared to single HLD in reducing bacterial contamination in nonoutbreak settings; however, EtO sterilization may help contain outbreaks caused by multidrug-resistant organisms. Drying endoscopes thoroughly after reprocessing is critical to prevent waterborne contamination, with recommendations to use adequate medical air flow for at least 10 minutes.<br /><br />Endoscope accessories that breach mucosal barriers must be sterilized between uses, and single-use accessories should not be reprocessed unless FDA guidance is followed. Water bottles used during endoscopy should undergo daily high-level disinfection or sterilization, and sterile water is recommended for procedures traversing mucosa. Use of simethicone as a defoaming agent should follow manufacturer guidance due to concerns about residue persisting in endoscopes.<br /><br />The guideline emphasizes the importance of a qualified, interdisciplinary infection control leadership team within endoscopy units to oversee infection prevention, manage outbreaks, and ensure compliance with reprocessing standards.<br /><br />Areas needing further research include optimal training approaches, the role of borescopes and ATP testing in monitoring cleaning efficacy, maximum endoscope storage duration post-reprocessing, and the efficacy of disposable endoscopes.<br /><br />The guideline concludes that rigorous, standardized reprocessing protocols combined with ongoing staff education and quality assurance are essential for minimizing infection transmission via GI endoscopy. Special considerations during the COVID-19 pandemic affirm that standard reprocessing effectively inactivates coronaviruses, and no protocol changes are needed.<br /><br />An erratum notes updated endorsing organizations as of 2021, reflecting broader professional society involvement.

Keywords

flexible gastrointestinal endoscopes

reprocessing guidelines

high-level disinfection

infection prevention

Spaulding classification

automated endoscope reprocessor

endoscope drying and storage

staff training and competency

ethylene oxide sterilization

COVID-19 and endoscope reprocessing