Aims Recreational Ketamine use is increasing, and with it the recognition of ketamine
induced cholangiopathy. The exact pathophysiology remains unclear however it is hypothesised
that an increase in chronic inflammation and fibrosis leads to biliary stricture along
with an increase in ketamine metabolites in the urine and bile leading to direct toxic
injury with repeated use. We report here our single-centre experience of caring for
patients with biliary complications of ketamine use [1]
[2]
[3].
Methods A retrospective analysis was performed of all patients who were diagnosed with ketamine-induced
cholangiopathy at University College London Hospital over 2 years (2022-2024). The
diagnosis was based on radiological evidence of clinically relevant cholangiopathy;
history of significant ketamine use; no alternative aetiology. Baseline patient demographics,
symptomatology, imaging and blood results were analysed from the electronic patient
record, and subsequent management and clinical outcomes recorded.
Results 10 patients were identified over the study period: 7 females, 3 males (mean age 34
years old (range 25 – 47). 8 patients (80%) had a normal bilirubin and imaging showing
diffuse biliary ductal changes (cholangiopathy), without a dominant stricture. 9 of
10 patients (90%) had concomitant ketamine uropathy. One patient (patient 2) was jaundiced
due to a tight distal biliary stricture and required biliary intervention. The stricture
could not be traversed at ERCP, and so the patient underwent an endoscopic ultrasound
guided choledochoduodenostomy for biliary drainage. The other patient with jaundice
(patient 5) had a severe intrahepatic cholangiopathy with liver failure and no options
for biliary intervention.
Conclusions This study highlights the emerging public health issue of ketamine induced cholangiopathy.
It appears to be strongly associated with ketamine induced uropathy. Whilst the majority
of patients in our series had limited active problems due to cholangiopathy, advanced
liver disease may develop and strictures appear to be extremely fibrotic. It is presumed
that total dose exposure of ketamine predicts cholangiopathy, and that cessation slows/prevents
disease progression, but this is unproven. Therefore, increased clinician awareness
of ketamine-induced cholangiopathy is vital, in addition to public awareness of the
problem, particularly given the increasing prevalence of recreational use of ketamine.
