Background Catheter/guidewire exchanges during ERCP require the coordinated ef forts of an endoscopist and endoscopy assistant. Aprototype duodenoscopewas deve loped to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever. MethodsAn initial prototype duodenoscope a nd a subsequent modification of this instrument were used to perform ERCP in 7 a nd 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 satisfactio n. Observations The initial and the modified prototype duodenoscopes were used i n a variety of catheter/guidewire exchanges (n=46). Guidewire fixation was achie ved in 75%of catheter/guidewire exchanges with the initial prototype and in 93 %with the modified prototype and was reflected in shorter exchange times. Acces s to the desired duct was not lost during any exchange, and the need for reposit ioning was eliminated. Conclusions A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of c atheter/guidewire exchange during ERCP. Modifications made to the original proto type improved reliability of guidewire fixation. Background Catheter / guidewire exchanges hours during ERCP require the coordinated ef forts of an endoscopist and endoscopy assistant. Aprototype duodenoscopewas deve loped to improve the control of catheter / guidewire exchange by enabling fixation of guidewires at the elevator lever. Methods Ann Initial prototype duodenoscope a nd a subsequent modification of this instrument were used to perform ERCP in 7 a nd 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 satisfactio n. Observations The initial and the modified prototype duodenoscopes were used in variety of catheter / guidewire exchanges (n = 46). Guidewire fixation was achie ved in 75% of catheter / guidewire exchanges with the initial prototype and in 93% with the modified prototype and was reflected in shorter exchange times. Acces s to the desired duct was not lost d uring any exchange, and the need for reposit ioning was eliminated. Conclusions A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of c atheter / guidewire exchange during ERCP. Modifications made to the original proto type improved reliability of guidewire fixation.