Objective To understand the current status of application, management, and maintenance of automated endoscope reprocessors (AERs) in China. Methods A questionnaire survey was conducted using convenience sampling method on the application, management, maintenance, and monitoring of AERs, as well as personnel training in digestive endoscopy centers of 292 medical institutions (MIs). Results A total of 316 questionnaires were distributed, and 292 were available, with an effective response rate of 92.41%. Among the 292 MIs, 198 (67.81%) were equipped with AERs, with equipment rates of 75.11% in tertiary MIs and 41.27% in secondary MIs. 88.38% of MIs performed manual cleaning before placing endoscopes into AERs, while 2.02% of MIs still didn’t perform this step, mainly in tertiary MIs. The most common problems in the application of AERs were the detachment or damage of connecting pipes (83.33%), followed by disinfectant leakage of AERs (43.94%), malfunction of control panel (43.94%), and failure or poor water flow of AER pipeline (42.93%). 92.42% of MIs regularly disinfected AERs, 72.73% of MIs regularly replaced AER air filters, and 80.30% of MIs regularly replaced AER water filters. 96.46% of MIs monitored the concentration of disinfectants before daily application of AERs, 87.88% of MIs regularly monitored the final rinse water of AERs, and 96.97% of MIs provided professio-nal training for new employees to use AERs for the first time. Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved. Most MIs are able to monitor and maintain AERs well, but there are still many problems in the application process. Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs, it is necessary to optimize workflow and strengthen training. Secondary MIs face challenges such as equipment shortages and low monitoring execution rates, requiring increased funding and regulatory efforts. It is recommended that manufacturers continuously optimize AER design, MIs establish standardized AER application protocol, and relevant departments improve AER application and ma-nagement standards, in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.