The clinical profile of Ketamine Cholangiopathy – a case series

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.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Austin AS. et al. Cholestasis and biliary dilatation associated with chronic ketamine abuse: a case series. Singapore Med J 2011; 52: e52
• 2 Nasiri A. et al. Features of biliary tract diseases in ketamine abusers: a systematic review of case reports. Journal of Medical Case reports 2024; 18: 84
• 3 Wong V. et al. Liver injury is common among chronic abusers of ketamine. Clin Gastroenterol Hepatol 2014; 12: 1759-1762

Publication History

Article published online:
27 March 2025