Background and study aims:A new duodenoscope(the V-scope) ,with a modified elevator used in combination with a dedicated short guide wire,constitutes the V-system.This systemis intended to allow fixation of the guidewire at the elevator lever,thereby enhancing the speed and reliability of accessory exchange over a guide wire during ERCP.The aim of this study was to evaluate the extent to which the V-system provides improved efficiency in comparison with conventional duodenoscope and guide wire combinations.Patients and methods:This was an industry-sponsored multicenter randomized trial.Patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) procedures in which treatment was anticipated were randomly assigned to the V-system or to a conventional duodenoscope and accessories used routinely in each center.The parameters recorded included the total case time,fluoroscopy time,catheter/guide wire exchange time,guide wire repositioning,loss of guide wire access,and success or failure of guide wire fixation when using the V-system.Results:Fifty patients were included,22 in the conventional group and 28 in the V-system group.A total of 135 exchanges were carried out.The patients had up to six exchanges.The median exchange time was 19.4 s with the V-system and 31.7 s with the conventional systems(P < 0.001) .Guide wire repositioning was required less often in the V-system group(P = 0.0005) .The V-system effectively locked the guide wire in 63 of 71 exchanges(89%) .Loss of guide wire access occurred in two patients in the conventional group and four in the V-system group,attributable to failure to lock the guide wire early during the experience(no significant differences) .Conclusions:The V-system can effectively secure the guide wire during accessory exchange in ERCP and reduces the time required to exchange accessories.This may enhance overall efficiency during ERCP. Background and research aims: A new duodenoscope (the V-scope), with a modified elevator used in combination with a dedicated short guide wire, constituting the V-system. This system is intended to allow fixation of the guidewire at the elevator lever, thereby enhancing the speed and reliability of accessory exchange over a guide wire during ERCP. The aim of this study was to evaluate the extent to which the V-system provides improved efficiency in comparison with conventional duodenoscope and guide wire combinations. Patients and methods: This was an industry-sponsored multicenter randomized trial. Patients undergoing retinal delectoral cholangiopancreatography (ERCP) procedures in which treatment was anticipated were randomly assigned to the V-system or to a conventional duodenoscope and accessories used routinely in each center. time, fluoroscopy time, catheter / guide wire exchange time, guide wire repositioning, loss of guide wire access, and success or failure of guidewire fixation when using the V-system. Results: Fifty patients were included, 22 in the conventional group and 28 in the V-system group. A total of 135 exchanges were carried out. The patients had up to six exchanges. The median exchange time was 19.4 s with the V-system and 31.7 s with the conventional systems (P <0.001) .Guide wire repositioning was required less often in the V-system group (P = 0.0005). The V-system effectively locked the guide wire in 63 of 71 exchanges (89%). Loss of guide wire access occurred in two patients in the conventional group and four in the V-system group, attributable to failure to lock the guide wire early during the experience (no significant differences) .Conclusions: The V-system can effectively secure the guide wire during accessory exchange in ERCP and reduces the time required to exchange accessories. This may enhance overall efficiency during ERCP.