Immune Checkpoint Inhibitor Esophagitis: Clinical and Endoscopic Presentation, Treatment Outcomes, and Complications

INTRODUCTION: We characterized features of immune checkpoint inhibitor (ICI) esophagitis. METHODS: This was a retrospective cohort of biopsy-confirmed ICI esophagitis. RESULTS: Among 11,636 ICI-treated adults, 22 of 312 (7%) undergoing esophagogastroduodenoscopy had ICI esophagitis (0.2% overall). Concomitant luminal ICI toxicities occurred in 19 of 22 (86%); 8 of 22 (36%) had normal esophageal appearance. Most experienced symptom resolution with acid suppression, steroids, and/or biologic therapy; however, 1 developed refractory strictures. DISCUSSION: ICI esophagitis is rare, often coexists with other gastrointestinal toxicities, and may seem endoscopically normal, underscoring importance of biopsies. Symptoms are typically treatment-responsive, but histologic inflammation can persist. Rare severe complications highlight needs for recognition and tailored therapy.