Application of Prototype Duodenoscopes in an ERCP Referral Practice Richard A. Kozarek, Tamara H. Harrison Background: Current duodenoscopes are excellent technical tools whose limitations are related to working channel size and operator experience. Potential modifications to include image enlargement, enhancement (addition of pixels), modifications of the duodenscope shaft and modifications of the scope elevator may improve procedural success rate or decrease procedure time. Materials and Methods: Two new FDA approved Olympus Inc. (New Hyde Park, NY) therapeutic duodenoscopes were prospectively studied in 335 pts. Scope modifications included: 1.) a variably stiff scope shaft meant to hold the duodenoscope in place and improve ease of stent placement, and 2.) adaptation of the Q-scope electronic image with enlargement of the image size and the addition of 100,000 pixels to enhance image quality. Data collected included procedural success, therapy undertaken, time to initial cannulation, and whether the scope modification improved procedural ease because of improved vision, guidewire fixation, or ability to modify shaft stiffness. Results: 98% procedures were technically successful: Qscope 218, and variable stiffness scope 117 uses. Median time to cannulation was 6 minutes (range 1–30). Therapy was undertaken in 332 of the 335 pts and included CBD or PD sphincterotomy (159), stone extraction (116), stricture dilation (68), stent placement (188) or extraction (33), and miscellaneous (158). Forty-one patients underwent brush cytologies as an additional diagnostic procedure. The stiffening function of the variable stiffness duodenoscope was used in 58 cases of stent placement and felt to facilitate stent passage through an extremely tight malignant stenoses in 1 and preclude repeated scope fallback into the stomach in another. The Q-duodenoscope was associated with a dramatically improved image and was felt to facilitate the procedure in 213/218 cases (98%). Conclusions: Design changes in the current Olympus duodenoscopes may facilitate ease and success of ERCP procedures. Image enlargement and enhancement appear to be the most important modification, but prospective studies comparing these scopes to currently utilized JF-160 duodenoscopes will be required for definitive conclusions. T1280 The Relationship Between Juxtapapillary Duodenal Diverticula (JPDD) and Biliary Stone Disease Seung-Ok Lee, Hyun Chul Kim, In Hee Kim, Sang Wook Kim, Soo Teik Lee, Dae Ghon Kim Background/Aims: Juxtapapillary duodenal diverticula (JPDD) are acquired lesions and their incidence increases with age. The prevalence of JPDD in the general population is around 20%. JPDD does not usually provoke symptoms by itself but the possibility of an association with bile duct stones was suggested. The aims of the study were to investigate the frequency of JPDD in the patients with biliary stone disease or non-biliary stone diseases, and to determine the type of JPDD according to the relationship of the papilla with the diverticulum, and to assess the association between types of JPDD and biliary stone disease. Methods: 270 patients who underwent ERCP were analyzed retrospectively and divided into two groups: biliary stone disease group (group I, nZ196) and non-biliary stone disease group (group II, nZ74). Additionally, we performed side-view duodenoscopy to agematched 40 healthy subjects for a control group (group III). The type of JPDD was classified as follows: papilla adjacent to the diverticulum (type I), papilla on the margin of the diverticulum (type II), papilla within the diverticulum (type III). All groups were investigated the frequency and the type of JPDD. Results: The frequencies of JPDD in group I, group II, and group III were 49.5%, 17.5%, 25.0%, respectively. The increment of frequencies of JPDD with aging was observed in all groups and was statistically significant in the group I. In biliary stone disease group, bile duct diameter was greater in the patients with JPDD than in the patients without JPDD (15.7 mm vs. 13.7 mm, PZ0.006). The frequencies of JPDD according to the type were as follows: type I, type II, and type III were 50.5%, 27.8%, 21.6% in group I, 53.8%, 15.4%, 30.7% in group II, 100%, 0%, 0% in group III, respectively. The distribution of JPDD according to the type was not significantly different between group I and group II. In biliary stone disease group, bile duct diameter in the patients with type I, type II, and type III JPDD were 14.6 mm, 15.8 mm, 17.2 mm, respectively, but did not show statistically significant difference. Conclusions: The frequency of JPDD was higher in the patients with biliary stone disease and increased with aging. In biliary stone disease, bile duct diameter was greater in the patients with JPDD than in the patients without JPDD. These results suggest that JPDD develops with aging and causes biliary stone formation through the bile stasis and bile duct dilatation.