Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events
The use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is s...
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| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2024-11-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://www.e-ce.org/upload/pdf/ce-2024-003.pdf |
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| author | Min Kyu Kim Sung Wook Hwang |
| author_facet | Min Kyu Kim Sung Wook Hwang |
| author_sort | Min Kyu Kim |
| collection | DOAJ |
| description | The use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is suspected, endoscopic evaluation is recommended to differentiate it from other etiologies and assess the severity of colitis. The distribution of intestinal inflammation in ICI-related colitis demonstrates a high frequency of extensive colitis (23–86%). However, isolated right-sided colitis (3–8%) and ileitis (2–16%) are less prevalent. Endoscopic findings vary and predominantly encompass features indicative of inflammatory bowel disease, including aphthae, ulcers, diffuse or patchy erythema, mucosal edema, loss of vascular pattern, and friability. The presence of ulcers and extensive intestinal inflammation are associated with a reduced response to treatment. Microscopic inflammation can be observed even in endoscopically normal mucosa, underscoring the need for biopsies of seemingly normal mucosa. Histological findings present with acute/chronic inflammation and occasionally exhibit characteristics observed in inflammatory bowel disease, microscopic colitis, or ischemic colitis. The first-line therapeutic choice for ICI-related diarrhea/colitis with a common terminology criteria for adverse events grade of 2 or above is corticosteroids, whereas infliximab and vedolizumab are recommended for refractory cases. |
| format | Article |
| id | doaj-art-e06c19b116884a568be83cfcef6b3146 |
| institution | OA Journals |
| issn | 2234-2400 2234-2443 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj-art-e06c19b116884a568be83cfcef6b31462025-08-20T02:38:49ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432024-11-0157672573410.5946/ce.2024.0037893Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse eventsMin Kyu Kim0Sung Wook Hwang1 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaThe use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is suspected, endoscopic evaluation is recommended to differentiate it from other etiologies and assess the severity of colitis. The distribution of intestinal inflammation in ICI-related colitis demonstrates a high frequency of extensive colitis (23–86%). However, isolated right-sided colitis (3–8%) and ileitis (2–16%) are less prevalent. Endoscopic findings vary and predominantly encompass features indicative of inflammatory bowel disease, including aphthae, ulcers, diffuse or patchy erythema, mucosal edema, loss of vascular pattern, and friability. The presence of ulcers and extensive intestinal inflammation are associated with a reduced response to treatment. Microscopic inflammation can be observed even in endoscopically normal mucosa, underscoring the need for biopsies of seemingly normal mucosa. Histological findings present with acute/chronic inflammation and occasionally exhibit characteristics observed in inflammatory bowel disease, microscopic colitis, or ischemic colitis. The first-line therapeutic choice for ICI-related diarrhea/colitis with a common terminology criteria for adverse events grade of 2 or above is corticosteroids, whereas infliximab and vedolizumab are recommended for refractory cases.http://www.e-ce.org/upload/pdf/ce-2024-003.pdfdrug-related side effects and adverse reactionsendoscopy, gastrointestinalhistologyimmune checkpoint inhibitors |
| spellingShingle | Min Kyu Kim Sung Wook Hwang Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events Clinical Endoscopy drug-related side effects and adverse reactions endoscopy, gastrointestinal histology immune checkpoint inhibitors |
| title | Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events |
| title_full | Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events |
| title_fullStr | Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events |
| title_full_unstemmed | Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events |
| title_short | Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events |
| title_sort | endoscopic findings of immune checkpoint inhibitor related gastrointestinal adverse events |
| topic | drug-related side effects and adverse reactions endoscopy, gastrointestinal histology immune checkpoint inhibitors |
| url | http://www.e-ce.org/upload/pdf/ce-2024-003.pdf |
| work_keys_str_mv | AT minkyukim endoscopicfindingsofimmunecheckpointinhibitorrelatedgastrointestinaladverseevents AT sungwookhwang endoscopicfindingsofimmunecheckpointinhibitorrelatedgastrointestinaladverseevents |