Initial evaluation of a duodenoscope modified to allow guidewire fixation during ERCP.
BACKGROUND
Catheter/guidewire exchanges during ERCP require the coordinated efforts of an endoscopist and endoscopy assistant. A prototype duodenoscope was developed to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever.


METHODS
An initial prototype duodenoscope and a subsequent modification of this instrument were used to perform ERCP in 7 and 10 patients, respectively. The following were recorded: total procedure time, fluoroscopy time, catheter/guidewire exchange time, guidewire repositioning, loss of guidewire access, success or failure of fixation, and endoscopist satisfaction.


METHODS
The initial and the modified prototype duodenoscopes were used in a variety of catheter/guidewire exchanges (n=46). Guidewire fixation was achieved in 75% of catheter/guidewire exchanges with the initial prototype and in 93% with the modified prototype and was reflected in shorter exchange times. Access to the desired duct was not lost during any exchange, and the need for repositioning was eliminated.


CONCLUSIONS
A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of catheter/guidewire exchange during ERCP. Modifications made to the original prototype improved reliability of guidewire fixation.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19422, USA.
Michelle C
MC
Beilstein
Nuzhat A
NA
Ahmad
Michael L
ML
Kochman
William B
WB
Long
Janak N
JN
Shah
Gregory G
GG
Ginsberg
D002760:Cholangiopancreatography, Endoscopic Retrograde; D004384:Duodenoscopy; D006801:Humans; D010865:Pilot Projects