Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 107798
Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.107798
Endoscopic insights into digestive-related adverse effects of immune checkpoint inhibitors: A narrative review
Grigorios Petrousis, Sylwester Szczegielniak, Haider Sabhan, Peter Elbe, Gülden Bilican, Hans Strid, Francesca Bresso, Charlotte Hedin, Stephan L Haas
Grigorios Petrousis, Hans Strid, Francesca Bresso, Charlotte Hedin, Stephan L Haas, Centre for Digestive Health, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm 17164, Sweden
Grigorios Petrousis, Haider Sabhan, Francesca Bresso, Charlotte Hedin, Department of Medicine Solna, Karolinska Institutet, Stockholm 17164, Sweden
Sylwester Szczegielniak, Peter Elbe, Centre for Digestive Health, Division of Endoscopy, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm 17164, Sweden
Haider Sabhan, Gastroenterology Unit, Department of Medicine, St Göran’s Hospital, Stockholm 11219, Sweden
Peter Elbe, Division of Surgery, Karolinska Institutet, Stockholm 17164, Sweden
Gülden Bilican, Department of Gastroenterology, Gazi University, Faculty of Medicine, Ankara 06, Türkiye
Stephan L Haas, Department of Medicine Huddinge, Karolinska Institutet, Stockholm 17177, Sweden
Author contributions: Petrousis G, Hedin C, and Haas SL conceptualized and designed the manuscript; Petrousis G, Haas SL conducted the literature search; Petrousis G drafted the initial manuscript; Petrousis G, Szczegielniak S, Sabhan H, Elbe P, Bilican G, Strid H, Bresso F, Hedin C, Haas SL contributed to the critical revision of the manuscript, making substantial contribution and providing expert opinion; All authors read and approved manuscript’s final version prior to publication.
Conflict-of-interest statement: Elbe P has received lecture fees from Medtronic and Viatris; Strid H has served as a speaker, consultant and/or advisory board member for Abbvie, Janssen, Pfizer, Ferring, Takeda, Lily, MSD and Tillots; Bresso F has acted as national and/or local principal investigator for clinical trials for Janssen, Ferring, and AbbVie; Haas SL has served as a speaker for Takeda, Santax Medico, Tillotts Pharma, Johnson and Johnson, and Mediahuset; Hedin C served as a speaker and/or advisory board member for AstraZeneca, AbbVie, Dr. Falk Pharma and the Falk Foundation, Galapagos, Janssen, Pfizer, Ferring, Takeda, and Tillotts Pharma and received grant support from Tillotts Pharma and Takeda; The rest of the authors have nothing to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Petrousis, MD, Researcher, Centre for Digestive Health, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Eugeniavägen 6, Stockholm 17164, Sweden. grigorios.petrousis@ki.se
Received: April 1, 2025
Revised: April 18, 2025
Accepted: May 27, 2025
Published online: July 16, 2025
Processing time: 102 Days and 17.8 Hours
Abstract

Treatment with immune checkpoint inhibitors (ICIs) is an innovative therapy for managing certain types of malignancy and has the potential to improve overall patient survival significantly. The most widely used ICIs selectively target different receptors comprising programmed cell death-1 receptor, programmed cell death-ligand 1 receptor, and cytotoxic T lymphocyte antigen 4 receptor. The widespread utilization of ICIs over the past several years, however, is frequently accompanied by immune-related adverse events (irAEs) that substantially impact the patient’s quality of life, particularly those affecting the digestive system, including both the upper and lower gastrointestinal tract. Based on a literature search covering databases such as PubMed, Web of Science, Embase, and the Cochrane Library, we present an insight into primary gastrointestinal irAEs, with a special focus on endoscopic manifestations. Additionally, we analyze data regarding the pathogenetic mechanisms, diagnostic approaches, histological characteristics, and proposed therapeutic interventions for managing irAEs involving the gastrointestinal tract.

Keywords: Immune checkpoint inhibitors; Gastrointestinal tract; Endoscopy; Immune-related adverse events; Toxicity; Colitis; Enteritis; Gastritis

Core Tip: Inflammation of the gastrointestinal tract following immune checkpoint inhibitor administration is a frequently encountered adverse event that can significantly impact both the quality of life of the oncology patients and the overall efficacy of cancer therapy. Currently, standardized endoscopic protocols for the diagnosis and longitudinal monitoring remain unavailable. A comprehensive understanding of the macroscopic features and distinct inflammatory patterns during the endoscopy of the digestive tract is essential for the early and accurate diagnosis, contributing to the optimization of therapeutic strategies and clinical outcomes for patients with immune-related adverse events.