GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE guideline

ASGE guideline_infection control in GI endoscopy

Pdf Summary

This 2018 guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides comprehensive recommendations to prevent infection transmission during gastrointestinal (GI) endoscopy. While millions of GI endoscopies are performed annually in the U.S. with rare infectious complications, recent outbreaks involving multidrug-resistant organisms (MDRO), particularly carbapenem-resistant Enterobacteriaceae (CRE) linked to duodenoscopes, have raised concerns. These infections often arise from persistent contamination of complex endoscope components such as elevator channels despite adherence to high-level disinfection (HLD) protocols.<br /><br />The guideline highlights that flexible endoscopes, being heat-sensitive, require meticulous manual cleaning followed by HLD using FDA-approved chemical germicides. Proper reprocessing steps include cleaning, disinfection, rinsing, drying, and storage. Manual cleaning of endoscopes, especially the elevator mechanism in duodenoscopes and linear echoendoscopes, is critical to prevent biofilm formation and infection transmission. Sterilization is recommended for critical-use accessories that breach mucosa, like biopsy forceps, but repeated sterilization of endoscopes can damage equipment and is generally not recommended over HLD.<br /><br />The document reviews infection risks from various pathogens: bacterial infections are infrequent and usually due to lapses in cleaning; viral transmission from hepatitis B/C and HIV is extremely rare with guideline adherence; parasitic and fungal transmissions are rare; prion disease transmission is not reported, with special precautions advised only for variant Creutzfeldt-Jacob disease (vCJD) cases.<br /><br />Beyond reprocessing, the guideline stresses general infection control measures within endoscopy units, including strict hand hygiene, use of personal protective equipment (PPE), safe injection practices, and environmental cleaning. It underscores the importance of institutional policies, employee immunizations (e.g., HBV), and a dedicated infection control leader responsible for training, compliance monitoring, and quality assurance. In the event of reprocessing failure, immediate notification of patients and health authorities, along with serologic testing and counseling, is mandated.<br /><br />Overall, the ASGE affirms that infection transmission via GI endoscopy is very rare when current cleaning and infection control practices are rigorously applied, with special vigilance warranted for high-risk devices such as duodenoscopes. Ongoing staff training, quality assurance, and leadership engagement are essential for maintaining safety.

Keywords

Gastrointestinal endoscopy

Infection prevention

ASGE guidelines

Duodenoscope contamination

High-level disinfection

Multidrug-resistant organisms

Carbapenem-resistant Enterobacteriaceae

Endoscope reprocessing

Infection control measures

Biofilm prevention