Analysis of 59 ERCP lawsuits; mainly about indications

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Analysis of 59 ERCP lawsuits; mainly

about indications

B. Cotton MD, FRCP,

FRCS

Current affiliation: Digestive

Disease Center,

Medical University of South Carolina, ton,

South Carolina, USA

Received 31 March 2005; accepted 9

June 2005. ton, South

Carolina, USA.

Available online 22 February 2006.

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 Sixteen were withdrawn, and 14 were settled.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.

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