Original Article
Analysis of 59 ERCP lawsuits; mainly about indications

https://doi.org/10.1016/j.gie.2005.06.046Get rights and content

Background

This study reports the analysis of a personal series of 59 cases in which ERCP malpractice was alleged.

Methods

Half of the cases involved pancreatitis; 16 suffered perforation after sphincterotomy (8 of which involved pre-cutting), and 10 had severe biliary infection. There were 2 esophageal perforations. Fifteen of the patients died. The most common allegation (54% of cases) was that the ERCP, or the therapeutic procedure, was not indicated. Most of these patients had pain only, usually after cholecystectomy. Negligent performance was alleged in 19 cases, with corroborating evidence in 8. Inadequate postprocedure care was alleged in 5 cases, including 3 with a delayed diagnosis of perforation. Disputes about the extent of the education and consent process were common.

Results

The final outcome was available in 40 cases. Sixteen were withdrawn, and 14 were settled. Of the 10 that came to trial, half were defense verdicts.

Conclusions

The lessons are clear. ERCP should be done for good indications, by trained endoscopists with standard techniques, with good documented patient informed consent and communication before and after the procedure. Speculative ERCP, sphincterotomy, and pre-cuts are high-risk for patients and for practitioners.

Section snippets

Patients and methods

This paper reviews my personal experience over the last 10 years as an expert witness in 59 cases that involved ERCP where malpractice was alleged. All of these cases started with a call from a lawyer who represented a plaintiff or a defendant. My analysis includes only those cases that reached the stage of reviewing detailed medical records. Not all resulted in an official lawsuit or a claim. Documents on each case were reviewed to look for the types of patients, the spectrum of complications,

Results

The 59 cases came from 23 states, most from the southern United States. Only 3 of the procedures had been performed at academic centers; the remainder had been in community practice. Women patients predominated (48 women/11 men).

Discussion

There are only a few reports about lawsuits involving endoscopy.4, 5, 6, 7 The most common allegations against endoscopists in general are reported to be failure to diagnose (usually at colonoscopy) and perforations of the esophagus or the colon. It is not possible to ascertain the total volume of ERCP-related lawsuits in the United States, and we do not know whether they are increasing or whether this personal series is representative. The predominance of cases with poor indications (and some

Acknowledgments

I am pleased to acknowledge helpful criticisms of this manuscript, in development, by Drs. Nicholas Nickl and Alvin Zfass, and lawyers Lisa Kindy and James W. Saxton.

References (26)

  • P.B. Cotton

    How many times have you done this procedure, Doctor?

    Am J Gastroenterol

    (2002)
  • P.B. Cotton et al.

    Excellence in endoscopy; defining useful metrics

    Gastrointest Endosc

    (2006)
  • P.D. Gerstenberger

    Risk management for the endoscopy center

    Gastrointest Endosc Clin N Am

    (2002)
  • Cited by (0)

    See CME section; p. 464.

    View full text