Clin Endosc.  2023 Jul;56(4):499-509. 10.5946/ce.2022.208.

Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases

• Lee YS
• Jang JY
• Bae JY
• Oh EH
• Park Y
• Kwon YH
• Shin JE
• Lee JK
• Lee TH
• Paik CN

• KMID: 2544573
• DOI: http://doi.org/10.5946/ce.2022.208

Abstract

Background/Aims
This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability.
Methods
Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs.
Results
Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals.
Conclusions
The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Keyword

Endoscopic retrograde cholangiopancreatography; Endosonography; Legal liabilities; Medical errors; Patient safety

Figure

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  Fig. 1. Three types of medical disputes and specific types of pancreatobiliary endoscopy-related adverse events (AEs). (A) Procedure-related AEs. (B) Sedation-related AEs. (C) Safety-related AEs. PEP, post-endoscopic retrograde cholangiopancreatography pancreatitis.

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  Fig. 2. Clinical outcomes for procedure-related perforation. (A) Based on management types. (B) Based on surgical timing. NPO, nol per os; tx, treatment; CPR, cardiopulmonary resuscitation; ENGBD, endoscopic nasogastric gallbladder drainage.

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