Gallbladder toxicity was reported in most motesanib studies with varying frequency and at variable times after initiation of treatment.
A 44-year-old man was admitted due to severe epigastric pain. The patient was diagnosed with non–small cell lung cancer 9 months ago and received 6 cycles of chemotherapy with motesanib, paclitaxel, and carboplatin. Ultrasonography showed a large amount of sludge within gallbladder. Computed tomography scan demonstrated diffuse dilatation of biliary tree with distended gallbladder without evidence of stone and mild pancreatic swelling. Endoscopic retrograde cholangiopancreatography showed yellowish viscous mucoid plug impacting ampullary orifice and dilated bile duct with amorphous filling defect at distal half of common duct. Endoscopic sphincterotomy was performed to prevent biliary obstruction and recurrent pancreatitis after removal of mucoid material.
To the best of our knowledge, this is the first report of obstructive cholangitis and acute pancreatitis associated with sludge formation during motesanib therapy. Endoscopic sphincterotomy appears to be useful to treat and prevent biliary obstruction caused by motesanib-induced biliary sludge.
aDivision of Gastroenterology and Hepatology
bDivision of Hematology-oncology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Correspondence: Tae Nyeun Kim, Yeungnam University, College of Medicine, Daegu, Republic of Korea (e-mail: email@example.com).
Abbreviations: CBD = common bile duct, CT = computed tomography.
The authors have no conflicts of interest to disclose.
Patient's informed consent could not be obtained because the patient died due to progression of the disease before we wrote the case report.
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Received November 10, 2015
Received in revised form January 12, 2016
Accepted July 29, 2016