IMMUNE CHECKPOINT INHIBITORS AND SCLEROSING CHOLANGITIS

Abstract

Immune checkpoint inhibitors are widely used in clinical practice, and immune-related adverse events (irAE) have been reported. An irAE liver injury, cholangitis, has been reported to occur frequently in patients who respond to treatment with immune checkpoint inhibitors. Sclerosing cholangitis is rare, occurring in only 4.5% of patients with liver injury who respond to immune checkpoint inhibitor therapy, and often difficult to diagnose. Ultrasonography shows thickness of the bile duct wall, cholangiography shows no obvious obstruction or stenosis, and cholangioscopy shows erosions and ulcerative changes on the surface of the bile duct. In patients who use immune checkpoint-inhibitors, damage of the biliary system should always be considered as irAE sclerosing cholangitis, and a definitive diagnosis should be made using various imaging studies. Although irAE sclerosing cholangitis is treated using steroids, it is often refractory to treatment and intractable.