There are no published guidelines for the sterilization of the flexible nasendoscope and various techniques exist. We have conducted a randomized, prospective, blinded trial of the barrier Endosheath system versus immersion in Cidex disinfectant. Using a visual analogue assessment, there were no differences at a 99% confidence interval (CI) between the two techniques from the nursing assistant and patient perspectives. Image quality was assessed blinded and no difference could be detected at a 99% CI. The Endosheath offers the advantage of increasing the productivity of each nasendoscope as the sterilization time is reduced. It also provides barrier protection against cross-contamination, including prion diseases.