Office-based flexible sigmoidoscopy allows rapid assessment and management of suspected immune checkpoint inhibitor-related colitis

Alana Siev; Pamela Livingstone; Erika Tom; Tara Corso; Isabel Preeshagul; Michael Postow; Neil J. Shah; Rachel Niec; Mark Schattner; David M. Faleck

Authors Alana Siev, Pamela Livingstone, Erika Tom, Tara Corso, Isabel Preeshagul, Michael Postow, Neil J. Shah, Rachel Niec, Mark Schattner, David M. Faleck.

Abstract

Background Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are frequently complicated by immune-related adverse events, including immunotherapy-related colitis (irColitis). Early and accurate diagnosis, including endoscopy, is essential for appropriate management, yet the real-world feasibility and clinical impact of early endoscopic evaluation remain unclear.

Methods We conducted a retrospective analysis of patients who underwent office-based, unsedated flexible sigmoidoscopy between February 2019 and April 2022 as part of the RAPID-GI program at Memorial Sloan Kettering Cancer Center. The program was designed to expedite evaluation of suspected irColitis in ICI-treated patients via rapid GI consultation including sigmoidoscopy. A diagnosis of irColitis was confirmed based on histology review by expert GI pathologists.

Results irColitis was confirmed in 70% (66/94) of patients. Median time from referral to consultation including sigmoidoscopy was 8 days. Visible inflammation was present in 80% of patients with confirmed irColitis vs. 11% without (P<0.001); all irColitis cases showed histologic inflammation. All procedures were completed without sedation using enemas alone for bowel preparation, and no complications occurred. Findings led to management changes in 89% of irColitis cases, including initiation or adjustment of immunosuppressive therapies. Among patients without irColitis, 79% avoided unnecessary immunosuppression and 57% continued or resumed ICI therapy.

Conclusions Office-based flexible sigmoidoscopy is a safe, feasible, and high-yield diagnostic tool for suspected irColitis. A rapid access program enables timely diagnosis, guides therapy, minimizes unnecessary immunosuppression, and facilitates ICI continuation. This model may improve outcomes and should be considered for broader adoption among integrated oncology and gastroenterology care teams.

Keywords Immune-related colitis, immune checkpoint inhibitors, flexible sigmoidoscopy, rapid evaluation, immune-related adverse effects

Ann Gastroenterol 2025; 38 (4): 415-419