免疫检查点抑制剂相关胃肠道不良事件的内镜检查结果。

IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY
Min Kyu Kim, Sung Wook Hwang
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引用次数: 0

摘要

使用免疫检查点抑制剂(ICIs)治疗各种恶性肿瘤的情况越来越多。服用 ICI 后可能出现免疫相关不良事件,其中胃肠道不良事件占很大比例。当怀疑出现 ICI 相关腹泻/结肠炎时,建议进行内窥镜评估,以将其与其他病因区分开来,并评估结肠炎的严重程度。ICI 相关结肠炎的肠道炎症分布显示,广泛性结肠炎的发生率较高(23%-86%)。然而,孤立性右侧结肠炎(3-8%)和回肠炎(2-16%)的发病率较低。内镜检查结果各不相同,主要包括炎症性肠病的特征,包括溃疡、弥漫性或斑片状红斑、粘膜水肿、血管形态消失和易碎性。出现溃疡和广泛的肠道炎症与治疗反应减弱有关。即使在内镜下正常的粘膜上也能观察到微小的炎症,这说明有必要对看似正常的粘膜进行活检。组织学结果显示为急性/慢性炎症,偶尔也会表现出炎症性肠病、微小结肠炎或缺血性结肠炎的特征。对于与 ICI 相关的腹泻/结肠炎,如果不良事件的通用术语标准为 2 级或以上,则一线治疗选择为皮质类固醇,而对于难治性病例,则推荐使用英夫利昔单抗和维多珠单抗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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 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.

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来源期刊
Clinical Endoscopy
Clinical Endoscopy GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
8.00%
发文量
95
审稿时长
26 weeks
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