Dr Peter Cotton analyzed a personal series of 59 cases in which endoscopic retrograde cholangiopancreatography (ERCP) malpractice was alleged.
Dr Cotton reports that half of the cases involved pancreatitis, of which 16 suffered perforation after sphincterotomy, and 10 had severe biliary infection.
There were 2 esophageal perforations, and 15 of the patients died.
Dr Cotton noted that the most common allegation, in 54% of cases, was that the ERCP, or the therapeutic procedure, was not indicated.
| In 54% of cases, the allegation was that 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.
The final outcome was available in 40 cases, of which 16 were withdrawn, and 14 were settled.
Of the 10 that came to trial, it was observed that half were defense verdicts.
Dr Cotton concludes, “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.”