Large, comprehensive reviews of transmission of infection during endoscopy have demonstrated that when currently accepted reprocessing practices are followed (in the absence of faulty equipment), there have been no reported episodes of transmission of infection. The fundamental importance of this document is that it represents a truly international consensus of over 150 gastroenterology and digestive endoscopy societies around the world, committed to a simple, uniform, and comprehensive standard to maximize compliance. A particularly novel aspect of the present guideline is the “cascade” concept, which attempts to reconcile a “gold standard” for endoscope reprocessing with a “minimum standard” for areas with more limited local resources.