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Review
. 2022 Apr 20;10(5):763.
doi: 10.3390/healthcare10050763.

Clinical Characteristics of ICI-Related Pancreatitis and Cholangitis Including Radiographic and Endoscopic Findings

Ryota Nakano  1 , Hideyuki Shiomi  1 , Aoi Fujiwara  1 , Kohei Yoshihara  1 , Ryota Yoshioka  1 , Shoki Kawata  1 , Shogo Ota  1 , Yukihisa Yuri  1 , Tomoyuki Takashima  1 , Nobuhiro Aizawa  1 , Naoto Ikeda  1 , Takashi Nishimura  1 , Hirayuki Enomoto  1 , Hiroko Iijima  1
Affiliations
Review

Clinical Characteristics of ICI-Related Pancreatitis and Cholangitis Including Radiographic and Endoscopic Findings

Ryota Nakano et al. Healthcare (Basel). .

Abstract

The indications for immune checkpoint inhibitors (ICIs) have expanded to include carcinomas of various organs. However, as ICI therapy expands, the management of immune-related adverse events (irAEs) has become a problem. ICI-related pancreatitis and cholangitis are relatively rare irAEs. Although some patients with ICI-related pancreatitis and cholangitis are asymptomatic and do not require treatment, there have been reports of patients who did not respond to immunosuppressive therapy and died. Thus, the pathogenesis of ICI-related pancreatitis and cholangitis should be clarified immediately. Currently, the role of endoscopy in the diagnosis and treatment of inflammatory pancreatic and biliary duct diseases is becoming increasingly important. In this review, we summarize clinical characteristics as well as radiographic and endoscopic findings of ICI-related pancreatitis and cholangitis.

Keywords: ERCP; EUS; ICI-related cholangitis; ICI-related pancreatitis; irAEs.

PubMed Disclaimer

Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Endoscopic ultrasonography and contrast-enhanced computed tomography (CT) images of immune checkpoint inhibitor (ICI)-related pancreatitis. (a) Focal pancreatic enlargement at the pancreatic head with a mass-like lesion and poor contrast enhancement (arrowhead). (b) Focal hypoechoic mass-like findings with internal hyperechoic spots from the pancreatic head to the pancreatic uncinate process (arrowhead).
Figure 2
Figure 2
Contrast-enhanced computed tomography (CT) findings of immune checkpoint inhibitor (ICI)-related cholangitis. (a) In the arterial phase, the liver parenchyma is irregularly enhanced. Wall thickening of the extrahepatic bile duct (red, arrowhead) and dilatation of the intrahepatic bile ducts (orange, arrowhead) were also observed. (b) After starting steroid therapy, the irregularly enhanced hepatic parenchyma showed a marked improvement. Intrahepatic bile duct dilatation remained but gradually improved (orange, arrowhead).
See this image and copyright information in PMC

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