Endoscopic Cholecystoduodenostomy With Lumen-Apposing Metal Stent for Bile Duct Stricture in a Child with Neuroblastoma: A Case Report

Abstract

We report the use of endoscopic cholecystoduodenostomy in a 6-year-old child to manage postanastomotic stricture of the common bile duct (CBD) secondary to an intraoperative injury sustained during the resection of an abdominal neuroblastoma (NB). The patient was diagnosed with stage M NB, characterized by dissemination to the bone marrow and vertebrae, and MYCN amplification. Following multiple cycles of chemotherapy and subsequent hematopoietic stem cell transplantation, the patient was scheduled for surgical resection. Preoperative imaging identified several image-defined risk factors, including infiltration of the porta hepatis and of the duodenopancreatic complex. During the dissection of the tumor, an incidental injury to the CBD occurred, which was subsequently repaired via end-to-end anastomosis. Seven months postoperatively, the patient presented with obstructive jaundice due to an anastomotic stricture, which was successfully managed through the placement of an endoscopic ultrasound-guided lumen-apposing metal stent (LAMS) between the dilated gallbladder and the duodenum. In our experience, endoscopic cholecystoduodenostomy constitutes a novel approach for addressing postoperative iatrogenic CBD strictures in pediatric patients. Further research is warranted to elucidate its benefits and risks as well as to evaluate its long-term efficacy and potential for broader application.

Keywords

case report - neuroblastoma - common bile duct injury - cholecystoduodenostomy - endoscopy

Authors' Contributions

M.S.C., L.P., and S.A. contributed to the acquisition and detailed description of the clinical case. S.A., A.P., F.P., A.C., and P.G. contributed to the conception and design of the work, recognizing the importance of publishing this unique and innovative case.

Patients' Consent

Informed consent was obtained from the patient's parents for the publication of this case report and any accompanying images.

Publication History

Received: 22 December 2024

Accepted: 14 June 2025

Accepted Manuscript online:
22 July 2025

Article published online:
05 August 2025

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