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.
Beilstein
Michelle C
MC
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19422, USA.
Ahmad
Nuzhat A
NA
Kochman
Michael L
ML
Long
William B
WB
Shah
Janak N
JN
Ginsberg
Gregory G
GG
D002760:Cholangiopancreatography, Endoscopic Retrograde; D004384:Duodenoscopy; D006801:Humans; D010865:Pilot Projects