Gao Z, Zhang JX, Tian XD, Wu SK, Jin X. Rapid cholestasis improvement as key strategy for steroid-refractory immune-related cholangitis: A case report. World J Gastrointest Oncol 2025; 17(9): 108960 [DOI: 10.4251/wjgo.v17.i9.108960]
Corresponding Author of This Article
Xuan Jin, PhD, Department of Medical Oncology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China. jinxuanbdyy@outlook.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Sep 15, 2025; 17(9): 108960 Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.108960
Rapid cholestasis improvement as key strategy for steroid-refractory immune-related cholangitis: A case report
Zhao Gao, Ji-Xin Zhang, Xiao-Dong Tian, Shi-Kai Wu, Xuan Jin
Zhao Gao, Shi-Kai Wu, Xuan Jin, Department of Medical Oncology, Peking University First Hospital, Beijing 100034, China
Ji-Xin Zhang, Department of Pathology, Peking University First Hospital, Beijing 100034, China
Xiao-Dong Tian, Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
Author contributions: Gao Z and Jin X wrote the manuscript; Wu SK, Jin X and Tian XD were responsible for managing the patient, conducting the clinical diagnosis and treatment, and gathering data; Gao Z and Jin X oversaw the patient’s diagnosis and treatment, composition and submission of the manuscript; Zhang JX conducted diagnoses on patients' pathological puncture specimens and was responsible for the collection of pathological images. All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Xuan Jin, PhD, Department of Medical Oncology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China. jinxuanbdyy@outlook.com
Received: April 28, 2025 Revised: June 16, 2025 Accepted: August 7, 2025 Published online: September 15, 2025 Processing time: 142 Days and 2.5 Hours
Abstract
BACKGROUND
Steroid-refractory immune-related cholangitis, characterized by biliary obstruction, can be caused by drugs such as immune checkpoint inhibitors (ICIs). While there a few reports of sclerosing cholangitis after ICI administration, the therapeutic importance of local relief of obstruction has not been reported.
CASE SUMMARY
A 60-year-old female patient with biliary tract carcinoma and peritoneal metastasis developed elevated liver enzymes following four cycles of combined therapy with anti-PD-1 (Pembrolizumab) and a tyrosine kinase inhibitor. Magnetic resonance cholangiopancreatography indicated a thickening of the upper bile duct and pancreatic sections with narrow lumens. Digital peroral cholangioscopy revealed several erosions and surface vessel tortuosities coating the common bile duct. Endoscopic ultrasound revealed disruption of the middle lumen segment, with poorly defined wall structures. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated mucosal irregularities with tortuous surface vessels along the common bile duct. Angiographic imaging revealed irregular defects in the middle and lower common bile duct segments, while the proximal duct exhibited multifocal stenosis alternating with dilatation. Biopsy samples obtained via ERCP from the elevated mucosal lesions showed dense epithelial inflammatory cell infiltration, consistent with immune-related cholangitis. Both biliary enzymes can be decreased to a certain degree by corticosteroid and ursodeoxycholic acid therapy but are difficult to reduce to normal levels. Liver function normalized, and symptoms improved after local treatment for cholestasis (stent implantation).
CONCLUSION
Stent placement offers prompt alleviation of cholestasis and constitutes an effective therapeutic strategy for managing immune-related cholangitis.
Core Tip: Steroid-refractory immune-related cholangitis, characterized by biliary obstruction, can be caused by drugs such as immune checkpoint inhibitors (ICIs). While there a few reports of sclerosing cholangitis after ICI administration, the therapeutic importance of local relief of obstruction has not been reported. Stent implantation provides rapid relief from cholestasis and is an effective approach to the treatment of immune-related cholangitis.
