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ICI-related pancreatitis (ICI-P) is an uncommon but clinically significant toxicity with potential for irreversible pancreatic damage. This review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of ICI-P. The incidence ranges from 0.5% to 5.7% depending on definitions and regimens, with combination immunotherapy conferring a significantly higher risk. Histopathologically, ICI-P is characterized by acinar-centric T cell infiltration with temporal evolution from CD4\u2009+\u2009to CD8\u2009+\u2009predominance. Most cases present as asymptomatic lipase elevation rather than clinical pancreatitis; however, long-term sequelae, including pancreatic atrophy (44\u201355%), new-onset diabetes mellitus, and exocrine insufficiency, are increasingly recognized. The role of corticosteroids remains controversial, with evidence suggesting efficacy for acute symptoms but uncertain impact on long-term outcomes. Notably, ICI-P development may be associated with improved overall survival, potentially reflecting enhanced antitumor immunity. This review provides an evidence-based framework for diagnosis and management while highlighting unresolved controversies requiring further investigation.<\/jats:p>","DOI":"10.1007\/s00535-026-02389-2","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:17:22Z","timestamp":1775063842000},"page":"1059-1067","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Immune checkpoint inhibitor-related pancreatitis: a comprehensive review of epidemiology, pathophysiology, and management"],"prefix":"10.1007","volume":"61","author":[{"given":"Yoonchan","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongwook","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hyun","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Mo","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6156-8746","authenticated-orcid":false,"given":"Tae Jun","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"2389_CR1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1146\/annurev-pathol-042020-042741","volume":"16","author":"S Bagchi","year":"2021","unstructured":"Bagchi S, Yuan R, Engleman EG. 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