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ASGE guideline_Scope Reprocessing Comparison

Pdf Summary

This document by the ASGE Quality Assurance in Endoscopy Committee provides a comprehensive, comparative review of major organizational guidelines on gastrointestinal (GI) endoscope reprocessing, aiming to guide endoscopy units and regulatory agencies in infection prevention and compliance with accreditation standards.<br /><br />GI endoscopes are complex reusable instruments that require thorough reprocessing—including precleaning, manual cleaning, leak testing, high-level disinfection (HLD), rinsing, drying, and proper storage—to prevent patient infections from contaminated scopes. Multiple national and international organizations have published guidelines (ASGE-led Multi-Society, AAMI, AORN, APIC, SGNA, HICPAC, ESGE), each with varying emphases and evidence grading methods.<br /><br />Key consensus areas across guidelines include:<br /><br />- Staff must receive training and competency verification in reprocessing protocols.<br /><br />- Reprocessing should occur in designated, physically separated rooms away from patient care areas.<br /><br />- Precleaning begins immediately after use; cleaning solution must be aspirated through internal channels.<br /><br />- Leak testing per manufacturers' instructions must be performed; failed scopes should be repaired or removed.<br /><br />- Manual cleaning must follow manufacturers’ instructions and include brushing all channels.<br /><br />- HLD is an integral step, with disinfectants tested for minimum effective concentration (MEC) though testing frequency varies.<br /><br />- Rinsing and air drying (using filtered or medical-quality air) are recommended; alcohol flushing before drying is common but not uniformly endorsed.<br /><br />- Endoscope storage must allow scopes to hang freely and dry without touching surfaces or other scopes; storage cabinets should follow manufacturers' guidelines, though no consensus exists on cabinet types or maximum storage intervals before reprocessing.<br /><br />There are areas of variation or limited evidence regarding training frequency, types of brushes, rinsing water quality, use of automated reprocessors, sterilization of duodenoscopes, borescope inspection, microbiologic surveillance protocols, and accessory storage.<br /><br />Accessory instruments contacting mucous membranes require HLD; critical accessories breaching mucosa need sterilization between uses. Reprocessing documentation and endoscopy unit leadership with multidisciplinary teams are critical for ensuring compliance, outbreak management, and communication with regulatory bodies.<br /><br />Given heterogeneity among guidelines and regulatory expectations, endoscopy units should conduct risk assessments and align policies with nationally recognized standards suited to their setting. Future efforts must focus on harmonizing standards and generating evidence to resolve conflicts and improve patient safety in endoscope reprocessing.

Keywords

GI endoscope reprocessing

infection prevention

high-level disinfection

manual cleaning

leak testing

endoscope storage

training and competency

reprocessing guidelines

accessory sterilization

quality assurance in endoscopy