Effectiveness of Reprocessing Protocols for Reusable Endoscopes in Operating Rooms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Reusable endoscopes play a critical role in operating rooms, yet they continue to be a source of healthcare-associated infection when reprocessing practices are suboptimal. Despite the development of new disinfection and sterilization technologies, contamination events continue to occur, and the comparative effectiveness of different reprocessing strategies is uncertain. The aim was to systematically assess, by meta-analysis of randomized controlled trials (RCTs), the efficacy of various reprocessing protocols for reusable endoscopes in an operating room setting. Systematic review and meta-analysis according to PRISMA 2020 guidelines. PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar, and ClinicalTrials.gov were searched up to 2025. Eligible RCTs compared defined protocols for endoscope reprocessing regarding microbial contamination, procedure-related infection, or sterilization effectiveness. Risk ratio (RR) (95% CI) was pooled using random- or fixed-effects models as appropriate. Six RCTs of endoscope- or culture-based assessments were identified. No significant difference was found between experimental and control interventions regarding the presence of microbial contamination of any concern post-reprocessing. The RR was 0.84 (95% CI 0.61–1.15; I² = 60%). Experimental strategies significantly reduced contamination of a high-concern organism, with a RR of 0.52 (95% CI 0.33–0.80; I² = 0%). Successful reprocessing, defined as negative cultures, did not significantly differ between groups, with a RR of 0.98 (95% CI 0.89–1.08; I² = 95%). Sensitivity analysis confirmed that these findings were robust. Overall, improved reprocessing strategies do not significantly reduce overall microbial contamination or guarantee higher rates of successful sterilization compared with standard protocols, although they demonstrate a significant reduction in high-concern organism contamination. These findings highlight a limited but targeted benefit of advanced methods and underscore the need for further high-quality randomized trials to establish optimal and standardized endoscope reprocessing practices in clinical settings.