MANAGEMENT OF ENDOSCOPY RELATED TO THE BILIARY TRACT AND PANCREAS: LEARNING FROM JUDICIAL DECISIONS

Abstract

Twelve judicial decisions that were made until the end of 2018, pertaining to endoscopy related to the biliary tract and pancreas in a Japanese legal database were analyzed. All cases were associated with adverse events leading to the patientsʼ death: severe acute pancreatitis (8 cases), intestinal perforation (3 cases), and sepsis (1 case). The hospital won in 5 cases, and lost in 7. The issues were as follows: (1) explanation (4 cases), (2) cleaning, sterilization, safekeeping, etc., of endoscopic instruments (1 case), (3) indication (1 case), (4) endoscopic technique (9 cases), and (5) treatment of adverse events (9 cases). In the cases in which perforation occurred due to contact of the endoscope during endoscopic retrograde cholangiopancreatography (ERCP), the hospital lost. In the cases in which diagnosis of (severe) acute pancreatitis was delayed or acute pancreatitis received insufficient treatment, the hospital lost. Endoscopists who carry out ERCP should have sufficient skills not to perforate the intestine, and treat patients who develop acute pancreatitis after ERCP carefully and properly, because acute pancreatitis may worsen to severe pancreatitis and rapidly lead to the patientʼs death.