An adaptor, a system and a method to orient an elongate medical device in relation to an endoscope are provided. The adaptor includes a first portion and a second portion. The first portion includes a connecting portion to rotationally securable to a distal end of the first portion to the endoscope, a first lumen extending longitudinally through the first portion and operably connectable to a working channel of the endoscope, and one of an orienting key or a keyway extending longitudinally at least partially along the first portion. The second portion is releasably connectable to the first portion and includes the other of the key or the keyway extending longitudinally along at least a portion of the second portion and a second lumen operably connectable to the first lumen and configured to receive an elongate medical device rotationally secured in relation to the second portion therethrough.
