ArticleCanadian liver journal2026
Chronic ketamine use resulting in a reversible cholangiopathy: A case series from a single Canadian centre and review of the literature.
Article in Canadian liver journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Ketamine-related cholangiopathy is increasingly being described in America, Europe, and Asia, paralleling increases in ketamine use globally. However, ketamine-related cholangiopathy has not been described in Canada previously. We report three cases of ketamine-related cholangiopathy in Calgary, Alberta. Results: Between May 2024 and April 2025, three patients were assessed by the University of Calgary Liver Unit in Calgary, Alberta, Canada. Case 1 was a 28-year-old female referred for elevated liver enzymes and features concerning for sclerosing cholangitis identified on magnetic resonance cholangiopancreatography. Case 2 was a 40-year-old male referred due to features of sclerosing cholangitis identified on magnetic resonance cholangiopancreatography. Case 3 was a 33-year-old female referred for elevated liver enzymes with biliary dilation on abdominal CT scan. In all cases, a history of chronic ketamine use and a negative comprehensive workup for other etiologies strongly suggested ketamine as the cause of their presentations. Case 1 had normalization of liver enzymes and marked improvement of radiographic biliary changes at 3-month follow-up after complete cessation of ketamine. Case 2 reduced ketamine use by 50% and experienced similar clinical improvement at 3-month follow-up. Case 3 continued using ketamine, resulting in worsening liver enzyme elevations and persistent biliary tree imaging abnormalities. Conclusions: Chronic ketamine use should be considered in patients presenting with liver enzyme elevation and/or imaging evidence of biliary dilation. Increased awareness in Canada is essential to ensuring health care providers consider ketamine-related cholangiopathy in patients presenting with these clinical findings, as with ketamine cessation liver injury and biliary abnormalities are potentially reversible.
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