Recomendações para esterilização de endoscópios flexíveis: análise comparativa de guias nacionais e internacionais

Abstract

ABSTRACT INTRODUCTION: Flexible gastroscopes are essential devices for endoscopic practice; however, they present a high degree of structural complexity, which makes their processing difficult and increases the risk of cross-contamination. Despite technological advances and international recommendations, doubts persist regarding the need for sterilization of these devices, especially given the use of sterile accessories and the occurrence of outbreaks associated with inadequately reprocessed endoscopes. OBJECTIVES: To analyze national and international guidelines on the processing of flexible gastroscopes, with a specific focus on sterilization methods, in order to support safe practices aligned with scientific evidence. METHODOLOGY: This is a documentary research based on the analysis of 23 guidelines issued by scientific societies, regulatory bodies, and professional associations, published between 2006 and December 2025. The search followed the strategies proposed by Azevedo (2018), Castro Filho et al. (2020), and Guadagnin (2021), including documents found in databases and official websites of the institutions. The guidelines were analyzed using a standardized table containing items related to processing steps and recommendations related to sterilization. RESULTS: Of the 23 guidelines identified, 10 were updated since 2020 and three had not been considered in previous studies. No recommendation indicated the sterilization of flexible gastroscopes, either routinely or in outbreak events. Sterilization was mentioned in only six documents, exclusively for metallic accessories. The analyzed guidelines maintain high level disinfection as the standard, even in the face of limitations associated with biofilm elimination and the increasing reporting of outbreaks related to endoscopes processed according to protocol. DISCUSSION: The findings reveal a discrepancy between evidence of residual contamination and current scientific evidence. Recent literature points to significant shortcomings in the effectiveness of high-level disinfection, especially in devices with complex internal channels. Studies indicate residual contamination even after proper processing and highlight the need to revise the classification of endoscopes in Spaulding's classification, suggesting their reclassification as critical items. Despite this, the guidelines remain aligned with the traditional model, without advancing towards sterilization recommendations or proposals for technological adaptations that mitigate microbiological risks. FINAL CONSIDERATIONS: It is concluded that the national and international guidelines analyzed do not include sterilization as an applicable step for flexible gastroscopes, maintaining high level disinfection as the standard approach. However, the body of evidence reveals the need to review and harmonize these recommendations, considering the structural complexity of the devices, the persistence of outbreaks, and emerging microbiological challenges. The study reinforces the importance of integrating scientific evidence, technological innovation, regulation, and clinical practice to improve patient safety and the effectiveness of endoscopic reprocessing. Keywords: Flexible endoscopes; sterilization; high-level disinfection; guidelines; patient safety.