Clinical Endoscopy

Review

Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events: Min Kyu Kim, Sung Wook Hwang; Clin Endosc 2024;57(6):725-734. Published online August 29, 2024; DOI: https://doi.org/10.5946/ce.2024.003

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.

Citations

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Clinical, Endoscopic, and Histological Characteristics of Severe Immune Checkpoint Inhibitor-Induced Colitis
Diego Casas Deza, Cristina Polo Cuadro, Marta Gascón Ruiz, Manuel Barreiro-de Acosta, Míriam Mañosa, Francisco Rodríguez-Moranta, Yamile Zabana, Elena Céspedes Martínez, Ingrid Ordás, José Miranda Bautista, María José García, Irene García de la Filia Moli
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Enteropathogenic Escherichia coli and Bacterial Overgrowth Co-infection Exacerbating Immune Checkpoint Inhibitor-Induced Colitis
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Who is at risk for immune checkpoint inhibitor-induced colitis among Korean patients?
Ji Hyun Kim, Sung Chul Park
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Immunotherapy.2025; 17(9): 631. CrossRef
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
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Risk factors for steroid-refractory in immune checkpoint inhibitor-induced colitis: a retrospective cohort study
Ke Meng, Jing Chen, Junzhe Chen, Shengjie Sun, Hui Li, Guanzhou Zhou, Fei Pan
Frontiers in Immunology.2025;[Epub] CrossRef
CD8+ cell dominance in immune checkpoint inhibitor-induced colitis and its heterogeneity across endoscopic features
Min Kyu Kim, Hye-Nam Son, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Shinkyo Yoon, Sung Wook Hwang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef

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Original Article

Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea: Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee; Clin Endosc 2024;57(4):476-485. Published online April 12, 2024; DOI: https://doi.org/10.5946/ce.2023.198

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation.
Methods
This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm.
Results
Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power.
Conclusions
High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

Citations

Citations to this article as recorded by

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Rong Zhao, Zheng Chen, Qingyu Teng, Tao Xu, Qi Li, Helin Gong, Hongjun Ji, Hui Zhang
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PeerJ.2026; 14: e20634. CrossRef
Core curriculum for sedation in gastrointestinal endoscopy with a focus on practice: a proposal from the Korean Society of Gastrointestinal Endoscopy
Hong Sub Lee, Yun Jeong Lim, Jong-Jae Park
Clinical Endoscopy.2025; 58(2): 218. CrossRef
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Scientific Reports.2025;[Epub] CrossRef
Risk factors for suspected infectious fever after diagnostic upper endoscopy: propofol overdose in a retrospective study from Korea
Sunmin Lee, Jung-Hwan Lee, Jongbeom Shin, Boram Cha, Ji-Taek Hong, Kye Sook Kwon
Clinical Endoscopy.2025; 58(5): 703. CrossRef
The effects of ciprofol and propofol on hypoxemia during gastrointestinal endoscopy in overweight and obese patients: a randomized controlled trial
Jiaxin Chen, Lifei Lai, Shuhua Zhao, Yingqing Deng, Zhe Zhu, Jingling Tian, Qianqian Zhu
BMC Anesthesiology.2025;[Epub] CrossRef
A randomised controlled trial of high-flow nasal oxygen compared with standard oxygen delivery in obese patients undergoing gastroscopy
Ned Douglas, Reny Segal, Kane O’Donnell, Keat Lee, Roni Krieser, Paul Mezzavia, Shan Hung, Ying Wei Chen, Teresa Sindoni, Irene Ng
Anaesthesia and Intensive Care.2025;[Epub] CrossRef

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