The most common method of reprocessing flexible gastrointestinal (GI) endoscopes is cleaning and subsequent high-level disinfection, as low-temperature sterilization is often impractical.1

In this study, the research and development team from Advanced Sterilization Products examine the challenges of flexible endoscope reprocessing and the feasibility of low-temperature sterilization.

Although endoscopes should undergo cleaning and disinfection after every patient use, endoscope-related infection outbreaks have been reported and continue to increase at an alarming rate.2-5

N. Omidbakhsh et al. / Journal of Hospital Infection

Important factors that may compromise the cleaning and disinfection process for flexible endoscopes include1:

  • Complexity of endoscope design
  • Biofilm formation inside the lumen of endoscopes
  • Inadequate margin of safety


According to the study, sufficient decontamination of flexible endoscopes can be achieved through improved design by manufacturers, such as making them easier to clean and/or simply using more robust materials that can withstand sterilization.1

Modified endoscope design


Effective staff training


Process control/ monitoring


Use of detergents with proven efficacy against biofilms


Overcome current risk of flexible endoscope-related infection outbreaks

Remember, when it comes to endoscope reprocessing safety, ASP recommends:

1What can be sterilized, should be sterilized
2What cannot be sterilized, should be reprocessed in an advanced Automatic Endoscope Reprocessor

Helpful Resources

Here are some resources available on the ASP website you can use to help educate your teams on these important issues.


  1. Omidbakhsh, N., Manohar, S., Vu, R., & Nowruzi, K. (2021). Flexible gastrointestinal endoscope processing challenges, current issues and future perspectives. Journal of Hospital Infection 110, 133-138. Research funded by ASP

  2. Carbonne A, Thiolet JM, Fournier S, Fortineau N, Kassis-Chikhani N, Boytchev M, et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill 2010;15(48):19734

  3. Wendorf KA, Kay M, Baliga C, Weissman SJ, Gluck M, Verma P, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015;36(6):634e42

  4. Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect 2004;58(3):224e9

  5. Nelson DB. Infectious disease complications of GI endoscopy: part II, exogenous infections. Gastrointest Endosc 2003;57(6):695e711



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