Changes to ST91 for Flexible and Semi-Rigid Endoscopes Create Obstacles to Implement Standards and Offer Impractical, Inappropriate or Conflicting Guidance

AASLD, ACG, AGA, ASCRS, ASGE, SAGES and SGNA are committed to initiatives focused on eliminating healthcare-associated infections through improved education about evidence-based practices. While our societies appreciated the opportunity to engage in the discussion around the 2021 revision of ST91 Flexible and semi-rigid endoscope processing in health care facilities, the joint GI societies remain concerned and do not support some of the finalized revisions to the standards and therefore voted negative on vote for approval.

Each of our societies has endorsed the Multisociety guideline on reprocessing flexible GI endoscopes and accessories, which provides evidence-based recommendations for the reprocessing of flexible GI endoscopes based on rigorous review and synthesis of the contemporary literature and application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, included significant input from the endorsing organizations, and achieved consensus through redistribution. The process of revising ST91 and the final output varied significantly from the standards for guideline development expected by our societies, which led to our casting and maintaining negative votes on the final revised version of ST91 Flexible and semi-rigid endoscope processing in health care facilities.

While the GI community awaits the availability of widespread, cost-effective alternative endoscopes and novel reprocessing technologies, it is critical for our patients that the focus of the national dialogue continues for the more salient issues of training, oversight and enhancement of cleaning practices and technologies.

Fundamentally, our societies remain concerned about the inability for healthcare teams to implement and operationalize this ST91 standard at the practice level due to its length, construction, internal redundancies, disparate definitions, and, at times, conflicting recommendations. 

The full joint statement has been published online via Gastrointestinal Endoscopy.

About the American Association for the Study of Liver Diseases
AASLD is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. We foster research that leads to improved treatment options for millions of liver disease patients. We advance the science and practice of hepatology through educational conferences, training programs, professional publications and partnerships with government agencies and our GI sister societies.
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About the American College of Gastroenterology
About the American College of Gastroenterology Founded in 1932, the American College of Gastroenterology (ACG) is an organization with a membership of over 17,000 individuals from 86 countries. The College's vision is to be the preeminent professional organization that champions the prevention, diagnosis, and treatment of digestive disorders, serving as a beacon to guide the delivery of the highest quality, compassionate, and evidence-based patient care. The mission of the College is to enhance the ability of our members to provide world-class care to patients with digestive disorders and advance the profession through excellence and innovation based upon the pillars of Patient Care, Education, Scientific Investigation, Advocacy and Practice Management.
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About the American Gastroenterological Association
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.
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About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy and is the foremost resource for endoscopic education.
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About the American Society of Colon and Rectal Surgeons
The 4,000+ member American Society of Colon and Rectal Surgeons is the premier society for colon and rectal surgeons and other surgeons dedicated to advancing and promoting the science and practice of the treatment of patients with diseases and disorders affecting the colon, rectum, and anus. Its board-certified colon and rectal surgeons complete a residency in general surgery, plus an additional year in colon and rectal surgery, and pass an intensive examination conducted by the American Board of Colon and Rectal Surgery.
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About the Society of American Gastrointestinal and Endoscopic Surgeons
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a leading surgical society representing a global community of more than 7,000 surgeons bringing minimal access surgery and emerging techniques to patients worldwide. SAGES mission is to innovate, educate and collaborate to improve patient care with a vision of reimagining surgical care for a healthier world.
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About the Society of Gastroenterology Nurses and Associates, Inc. 
The Society of Gastroenterology Nurses and Associates, Inc. is a professional organization of nurses and associates dedicated to the safe and effective practice of gastroenterology and endoscopy nursing. SGNA carries out its mission by advancing the science and practice of gastroenterology and endoscopy nursing through education, research and collaboration, and by promoting the professional development of its members in an atmosphere of mutual support. For more than 35 years, SGNA has served as the voice of more than 5,000 members and their patients.
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