Pediatric ERCP with a single-use duodenoscope in an immunocompromised child

A 7-year-old girl with combined immunodeficiency (dedicator of cytokinesis 8 deficiency) was referred to our unit. During the last year, the patient had a persistent increase on liver function tests (alanine aminotransferase 3, GammaGT 6), a reduction in IgM (18 mg/dL), and an increase in IgE (300-600 mg/dL). Common bile duct dilatation (11 mm) with irregular intrahepatic ducts was evident on magnetic resonance cholangiography, and liver biopsy results were compatible with primary sclerosing cholangitis. Because the patient was a candidate for stem cell transplantation to treat immunodeficiency, after multidisciplinary discussion, biliary sphincterotomy was chosen to prevent worsening of biliary obstruction during the forthcoming transplantation period. To reduce the risk of duodenoscope-related infection in this immunocompromised child, ERCP was performed with a single-use duodenoscope (Exalt Model-D)