Purpose <p>Endoscope tip protectors (ETP) are commercially available, but their effect on reducing the number and type of damages to the instruments and the economic impact of reducing repair costs are largely unknown.</p> Methods <p>We conducted a prospective, blinded cohort, operational quality improvement study at a large, quaternary endoscopic referral center to assess the frequency and types of endoscope damage as well as analyze the effect on repair costs. A cohort of 21 upper endoscopes, 16 colonoscopes and 11 echoendoscopes was utilized. Phase 1 involved 1,800 procedures without ETP, followed by Phase 2 utilizing the ETP for 1,800 procedures. The endoscope cohort was assessed after each procedure, at the 900-procedure point, and at the end of each phase of the study to ensure the capture of any unidentified damage. A cost per case analysis (CPC) and cost-effectiveness analysis (CEA) were performed using the overall cost of damage repair per volume of procedures, from the perspective of the overall fleet as well as the specific types of endoscopes studied.</p> Results <p>ETP use was associated with a 36.4% decrease in overall fleet repair costs, from $167.64 to $106.72 per case, with a 48.7%, 64.7% and 28.4% CPC reduction respectively for upper endoscopes, colonoscopes and echoendoscopes. CEA found that the use of ETP dominated non-use for the entire endoscope fleet, upper endoscopes and colonoscopes but not echoendoscopes.</p> Conclusions <p>ETP was associated with a decrease in CPC repair costs and was the dominant practice strategy from a CEA standpoint for all endoscope classes except echoendoscopes. ETP use should be considered to reduce endoscope repair costs. Further studies are warranted to validate these findings.</p>