title: A case report of motesanib-induced biliary sludge formation causing obstructive cholangitis with acute pancreatitis treated by endoscopic sphincterotomy.
abstract: BACKGROUND
  Gallbladder toxicity was reported in most motesanib studies with varying frequency and at variable times after initiation of treatment.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology and Hepatology Division of Hematology-oncology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Jay
authors.initials: J
authors.lastname: Song
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Kim
authors.forename: Kook Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae Nyeun
authors.initials: TN
authors.lastname: Kim
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001646:Bile; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D002761:Cholangitis / Q000139:chemically induced* / Q000150:complications / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives*; D009841:Oligonucleotides; D010195:Pancreatitis / Q000209:etiology*; D016717:Sphincterotomy, Endoscopic
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D009841:Oligonucleotides; D009536:Niacinamide; C519562:imetelstat