Valium is virtually never used these days. Some endoscopists still use Versed (along with the opioid Fentanyl). Versed is a sedative in the same class as Valium, but it has a much more pronounced amnesia effect. The general concept is that Fentanyl is given to decrease the pain, and Versed is given so that the patient doesn’t remember the pain. People don’t actually go to sleep, they just don’t remember being awake. The trend toward Propofol, an actual anesthetic, is based on vastly improved patient satisfaction. It also makes the procedure easier, safer, and faster, with less disorientation, quicker recovery, and less hangover.

Ffiberoptic scopes have become more complex as surgeons do more and more procedures with them. That complexity entails more joints and moving parts thereby making them harder to clean. The main issues with recent concerns of scope cleaning revolve around duodenoscopes for ERCP rather than standard gastroscopes and colonoscopes. All of these scopes are washed, soaked, and terminally sterilized for each use. It’s an elaborate and expensive process. The mechanical complexity of duodenscopes makes them a more difficult device to mechanically clean.

Medical device sales people have a demanding job. They get paid a lot of money. I've never seen one in an OR or endoscopy suite in street clothes.