We read with great interest the article by Snyder et al1 comparing 3 different methods of duodenoscope disinfection or sterilization: standard high-level disinfection, double high-level disinfection (dHLD), and standard high-level disinfection followed by ethylene oxide gas sterilization. No multidrug-resistant organisms were identified on duodenoscope culture for the entirety of the study, which closed early owing to an inability to evaluate the primary outcome. However, any bacterial growth of more than 0 colony-forming units was observed in 16.1% of duodenoscopes in the standard high-level disinfection group, 16.0% in the dHLD group, and 22.5% in the standard high-level disinfection followed by ethylene oxide gas sterilization group.