Uncommon esophagitis associated with nivolumab and ipilimumab therapy

Abstract

cancer. Six months later, she developed obstructive jaundice due to recurrence, and a plastic stent was placed in the obstructed bile duct via the transpapillary route. However, she developed obstructive jaundice.We tried to perform transpapillary drainage again, but it failed due to tumor invasion to the duodenum. Consequently, we performed EUS-guided biliary drainage from the reconstructed gastric tube to the intrahepatic bile duct.From the gastric tube, we found the B3 using EUS, and we punctured the B3 from the reconstructed gastric tube (Fig 1 .). Subsequently, we inserted the guidewire and dilated the bile duct using a dilation catheter (ES dilator; Zeon Medical Co., Tokyo, Japan). Finally, we deployed a fully-covered selfexpandable metallic stent (NIR stent; 8-mmx 8-cm long covered stent; Olympus Tokyo, Japan; Fig 2). This procedure was completed without any adverse events.There have been many reports about EUS-guided biliary drainage via various routes. However, there have been no previous reports of EUS-guided intrahepatic bile duct fistulation from a reconstructed gastric tube. This is the first case report of this procedure. EUS-HGTS via a gastric tube route is a useful procedure as it can be implemented safely.

Pembrolizumab-induced esophagitis dissecans superficialis in a patient with squamous cell lung carcinoma

“…The first case 17) showed granulation tissue; the second case 14) showed lymphocytic inflammation, like our case; and the third case 15) did not undergo biopsy. One of the cases improved without treatment 15) , but in the other two, the ICI had to be discontinued and a steroid was administered 14,17) . Two of the treated cases experienced relapses; thus, unlike EDS without ICIs, EDS with ICIs does not always have a good prognosis.…”

“…Although specific treatment has not yet been established, prognosis is reported to be good in the natural course 27) . We found three previous case reports on EDS due to ICIs 14,15,17) (Table 1). The first case 17) showed granulation tissue; the second case 14) showed lymphocytic inflammation, like our case; and the third case 15) did not undergo biopsy.…”

“…We found three previous case reports on EDS due to ICIs 14,15,17) (Table 1). The first case 17) showed granulation tissue; the second case 14) showed lymphocytic inflammation, like our case; and the third case 15) did not undergo biopsy. One of the cases improved without treatment 15) , but in the other two, the ICI had to be discontinued and a steroid was administered 14,17) .…”

“…Currently, ICIs are used for advanced cancers, and they often cause irAEs, including gastrointestinal mucositis. ICIs-induced esophagitis is thought to be rare and to our knowledge, 26 previous cases of esophagitis caused by ICIs have been published: 10 cases with nivolumab 2-11) , 4 with nivolumab and ipilimumab [12][13][14][15] , 9 with pembrolizumab 8, [16][17][18][19][20][21][22][23] , 1 with atezolizumab 24) , 1 with avelumab 25) , and 1 with durvalumab 26) . In many of these cases, besides discontinuation of the ICI, administration of corticosteroids was required.…”

Esophagitis Dissecans Superficialis After Thermal Injury

“…This esophageal lesion has been reported in association with desquamating dermatological disorders, physical trauma, chemical irritants, anticoagulants, and immunotherapies. [1][2][3][4][5][6][7] Furthermore, EDS has been observed more frequently in debilitated patients. 8 Endoscopic presentation of EDS typically involves whitish strips of easily detachable esophageal mucosa underlined by normal-appearing mucosa.…”