Abstract: This article systematically reviews the epidemiological evolution of endoscopy-associated infections (EAIs)， from the predominant concern over Helicobacter pylori in the late 20^th century to the frequent outbreaks of multidrug-resistant organisms (MDROs) in the 21^st century. The review provides an in-depth analysis of structural vulnerabilities in complex endoscopes-particularly duodenoscopes-including cleaning dead spaces created by the elevator mechanism， O-rings， and fixed distal caps， and highlights the critical role of biofilms in the failure of reprocessing protocols. Risk factors for EAIs are systematically examined from three dimensions: patient-related， procedure-related， and device-related factors. Regarding surveillance techniques， the article emphasizes the innovative values of the flush-brush-flush sampling method (FBFSM) and next-generation sequencing (NGS). The prevention and control strategies targeting exogenous infection and endogenous infections were proposed respectively and were integrated into a four-pillar and end-to-end infection control framework encompassing 'surveillance-tracing-design-reprocessing'.