Complications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events

Abstract

Introduction:The number of malpractice claims against physicians and health institutes is increasing continuously in Israel as in the rest of the Western world, and has become a serious financial burden.Aim:In this study we analyzed the reports of gastroenterologists on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) adverse events to the risk management authority between January 1, 2000 and December 31, 2006.Methods:All the reported adverse events associated with ERCP and EUS of health institutes and covered by Madanes Insurance Agency were summarized and analyzed. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an Excel worksheet, discussed, and evaluated.Results:Forty-two cases of ERCP and EUS adverse events were reported. There were nine cases of men (21.4%) and the average age was 69.3 ± 14.3 years. During this period, 10,647 procedures were performed by the institutes concerned and the number of adverse events was 20.2 to 67.8 per year for 10,000 procedures. Perforation occurred in one out of 367 procedures, bleeding in one out of 5323 procedures, teeth trauma in one out of 5323 procedures, and respiratory complications in one out of 10,647 procedures.Conclusion:This is the first study in Israel about physicians’ reports of ERCP and EUS adverse events. Physicians reported only about severe adverse events with high rate of mortality and morbidity.

Sudden appearance of free fluid during endoscopic ultrasound-guided fine-needle aspiration

“…However, the most feared complication related to EUS is perforation, with a reported incidence between 0.075% following diagnostic procedures to 0.25% following interventions. [ 2 ] Duodenal perforation is the most common type, accounting for 6 out of 10 cases in a German study,[ 3 ] the most important responsible factors being, besides the physical characteristics of the echoendoscopes[ 4 ] (lack of forward viewing, higher rigidity and stiffness of the scope tip, larger diameter compared to gastroscopes or even duodenoscopes, longer nonflexible section just proximal to the transducer, and presence of a rigid segment containing the transducer that extends beyond the optical lens), also the significantly longer duration of the EUS examination compared with standard upper digestive endoscopy. [ 5 ] Moreover, patients who undergo EUS-FNA are approximately 10 times more likely to suffer complications following EUS compared to patients undergoing diagnostic noninterventional EUS,[ 6 ] with most of the fatal complications occurring after examinations by endoscopists who have performed fewer than 300 EUS procedures.…”