A therapeutic ERCP in an only 5.9 kg infant with obstruction jaundice using JF-260V duodenoscope

TL;DR

A 5.9 kg infant with biliary obstruction successfully underwent therapeutic ERCP using an adult duodenoscope, showing it can be safe in expert hands.

Contribution

Demonstrates the feasibility of using a conventional adult duodenoscope for therapeutic ERCP in a very low-weight infant.

Findings

ERCP with JF-260V duodenoscope successfully extracted stones and drained bile in a 5.9 kg infant.

The procedure was performed safely under general anesthesia in a center with ERCP and pediatric expertise.

The case highlights the need for standardized guidelines for pediatric ERCP procedures.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has found extensive use in pediatric patients; however, challenges persist in the application of therapeutic ERCP in infants.

This case report details the presentation of a 5.9-kilogram infant with obstructive jaundice and suspected hemolytic anemia who underwent ERCP to alleviate biliary obstruction. The infant was admitted due to clay-colored stools, jaundice, and liver injury. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed dilation of the common bile duct (CBD) accompanied by the presence of stones. ERCP was conducted using a JF-260V duodenoscope under general anesthesia. Successful stone extraction and biliary drainage were achieved.

In centers with considerable expertise in ERCP and pediatric anesthesia, the use of a conventional adult duodenoscope for therapeutic ERCP in infants can be considered safe and feasible, provided careful and stringent patient selection criteria are applied. In the future, clear guidelines and standardized protocols for the indications and procedures of pediatric ERCP should be established.

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