1. The recent outbreaks have prompted a plethora of recommendations for further reducing the risk of duodenoscope transmission while also maintaining an adequate supply of instruments for patient care. The FDA has advised (a) enhanced oversight, training, and competency assurance for front line reprocessing staff, (b) assiduous attention to precleaning and cleaning steps before usual automated high-level disinfection (HLD), (c) adherence to manufacturer’s instructions for use, including use of singular proprietary cleaning brushes used by the manufacturers in their validation studies for reprocessing, and (d) new emphasis on record keeping regarding all of these varied measures. Specific short term recommendations from AGA include surveillance of all patients who have had a procedure using an elevator channel endoscope, tracking of each elevator channel endoscope by patient and device serial number, and periodic collection of cultures from all elevator equipped endoscopes currently in use within a practice.