Currently, the most common method of handling flexible gastrointestinal (GI) endoscopes is cleaning, followed by high-level disinfection, as terminal sterilization is often impractical.1

In this study, the research and development team from Advanced Sterilization Products examines endoscope processing challenges and the practicability of terminal sterilization.

Although endoscopes go through a cleaning and disinfection process after every patient use, infection related cases linked to endoscopes are reported and continue to increase at an alarming rate.2-5

N. Omidbakhsh et al. / Journal of Hospital Infection

Three important factors that compromise the cleaning and disinfection process of flexible endoscopes1:

  • Complexity of the GI endoscope design 
  • Formation of biofilms inside the lumens 
  • Inadequate margin of safety


According to the study, decontamination or sterilization of flexible endoscopes can be achieved by the endoscope manufacturers’ ability to design them to be 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 effectivity 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 AER/ECR


  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