An Endoscopic Retrograde Cholangio-Pancreatoscopy (ERCP) is a device that combines endoscopy and fluoroscopy to enable consultants such as gastroenterologists to examine organs like the pancreas, bile ducts, and gallbladder. With the endoscope passing through the stomach and duodenum, dyes are injected into the pancreas, biliary tree, and ducts to facilitate x-ray imaging.
An ERCP is generally used in cases where patients present with abnormal liver function tests with a dilated common bile duct, gallstones and pancreatitis, or biliary stones.
There are risks associated with an ERCP procedure and a gastroenterologist or other medical professional may be negligent in the following situations:
- The patient did not consent to the ERCP procedure and were not fully informed of the risks.
- The ERCP procedure was not carried out safely or properly as per the relevant guidelines at the time and the consultant’s negligence led to the perforation of an organ or duct eg the patient’s bile, hepatic and pancreatic ducts as well as the duodenum, oesophagus, liver, or spleen. Perforation of an organ or part of digestive system can lead to abscess formation, pancreatitis, peritonitis, sepsis and in extreme cases, death.
“Perforation most frequently happens following sphincterotomy but balloon dilation, guidewire manoeuvrers, and the tip of the endoscope may also cause this AE [adverse event].”
- Failure to remove gallstones safely i.e. mistakes were made in performing an ERCP resulting in damage or cuts to the bile duct – leading to post-ERCP pancreatitis with necrosis of the pancreas and also diabetes.
- Failure to diagnose and treat, pancreatitis or inflammation of the pancreas following a ERCP
- Bleeding due to sphincterotomy and the failure to manage the complications
- Mistakes made in placing a stent in the pancreatic duct or the bile duct or placing a stent in the wrong duct
- The development of a hepatic hematoma / tears in the liver
- The cause of the patient’s deteriorating health was not properly investigated after an ERCP was performed.
- Emergency remedial treatment or surgery was not carried out after post ERCP complications were identified.
- The ERCP was not required and less invasive treatments should have been considered.
- The ERCP was not required and other diagnostic tools should have been considered first eg. ultrasound, Magnetic resonance (MR) cholangiography, CT Cholangiography, Magnetic resonance cholangiopancreatography (MRCP), Endoscopic Ultrasound
- Pre-existing health conditions which may lead to complications and should have been considered by the medical professionals before performing the ERCP procedure. The management of potential complications may be affected by pre-existing conditions eg. cardiac conditions.
- The patient developed an infection eg. hepatitis due to the use of a poorly cleaned endoscope.
According to the European Society of Gastrointestinal Endoscopy (ESGE) the most common adverse events (unexpected medical problems) after an ERCP include:
- Sedation related adverse events
Signs of ERCP Complications
Some indications of ERCP complications could include:
- Vomiting, especially if blood is present.
- Bloody or very dark stool.
- Breathing difficulties
- Discomfort when swallowing due to worsening throat pain.
- Chest pain.
- Worsening abdominal pain.
Complications and signs of infection following an ERCP must be attended to immediately.
If left untreated, pancreatitis and the perforation of the duodenum and other areas can lead to a cascade of life-threatening complications. These include:
- Tissue death; this is also known as necrosis.
- Sepsis may occur. Sepsis is the body’s extreme response to an infection, and it is life-threatening. It occurs when an infection triggers a chain reaction throughout the body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract.
- Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels. It is caused by another disease or condition, such as perforation, that affects the body’s normal blood clotting process.
- Multiple organ failure.
The Most Commonly Perforated Organs During an ERCP Procedure
Langerth, A., Isaksson, B., Karlson, BM. et al. ERCP-related perforations: a population-based study of incidence, mortality, and risk factors. Surg Endosc 34, 1939–1947 (2020). https://doi.org/10.1007/s00464-019-06966-w
Is Pancreatitis Associated with the ERCP Procedure?
Pancreatitis is inflammation of the pancreas and it can be caused by an ERCP.
Other potential causes of acute and chronic pancreatitis include:
- Gall stones
- Genetic conditions
- Infections eg. viruses, parasites
- Injury to the abdomen
- Pancreatic cancer
- High lipid and calcium levels in the blood
The development of pancreatitis following an ERCP is rare. However in severe cases pancreatitis complications following an ERCP can include:
- internal bleeding
- respiratory problems
- infection resulting from inflammation in the tissue – this could potentially lead to sepsis
- Pancreatic necrosis a condition in which severe inflammation in the pancreas leads to the death of pancreatic tissue.
- Peripancreatic necrosis may also occur in which the fatty tissue surrounding the pancreas dies. The dead pancreatic and fatty tissue caused by pancreatic necrosis is vulnerable to infection and other pancreatitis complications.
- Systemic inflammatory response syndrome (SIRS) can result from pancreatic inflammation spreading throughout the body and could lead to organ failure.
- Hypoxia or low oxygen levels in the blood. Pancreatitis may lead to impaired respiratory function and low oxygen levels in the blood. This lack of oxygen can affect cells and tissues throughout the body.
The risk of developing pancreatitis following an ERCP
The European Society of Gastrointestinal Endoscopy (ESGE) states that patients should be considered high risk for developing post ERCP pancreatitis when at least one definite and two likely patient-related or procedure-related risk factors are present. These risk factors are presented in the table below:
- Pancreatitis after ERCP may occur if the patient experiences damage to the pancreas during the procedure. This may include prolonged manipulation of the pancreas, the ducts or surrounding organs, injections of a contrast medium to aid X-ray results, and difficulty during cannulation. Cannulation involves inserting a cannula, or tube-like instrument, into a duct or sphincter to drain bile or pancreatic fluid.
- Infections following an ERCP and allergic reactions to chemicals or instruments used in the procedure could also result in pancreatitis.
- Endoscopic sphincterotomy is a common cause of pancreatitis after an ERCP. Endoscopic sphincterotomy involves several types of instruments being inserted through the endoscope, inserted during an ERCP. The sphincter, or group of muscles that controls the flow of pancreatic fluid and bile, is cut or stretched. This procedure facilitates the removal of stones and also allows a stent (drain) to be inserted to open up an narrowed areas.
Common symptoms for pancreatitis after ERCP may include:
- Abdominal pain that burns and radiates to the back
- Nausea and vomiting that may worsen with eating
- Fever and jaundice, or yellowing of the eyes and skin
- Internal bleeding
- Elevated blood pressure and heart rate
- Decreased blood pressure due to bleeding or dehydration
Long-term Effects of ERCP Complications
These may include:
- Brain damage
- Hearing impairment
- Weak limbs leading to reduced balance when standing or walking—as well as possible amputations if necrosis has spread.
- Constant fatigue, sectional pain, bowel restrictions,
These developments significantly impair the quality of life and have a negative impact on day-to-day activities.
Claim Compensation For ERCP Negligence
If you have undergone an ERCP procedure and you feel that your gastroenterologist was negligent and made serious mistakes during the procedure, you could be entitled to claim compensation. Mistakes could also have been made in the hospital care provided after the ERCP procedure.
Devonshires Claims has over 20 years’ experience in obtaining justice and compensation for victims of medical negligence. We have clients throughout England and Wales and have been recognised in Legal Directories such as the Legal 500.
We offer our clients:
- A friendly, compassionate and professional claims service
- A free case evaluation
- No Win No Fee agreement
- Access to a network of medical experts and specialist barristers
- Our expertise in dealing with a variety of medical negligence claims including very complex medical cases
- Our expertise in securing the maximum compensation available
£2 million compensation for negligent hospital treatment resulting in air embolism and stroke
Claim following removal of a central line with the patient sat in a chair. This led to an air embolism and stroke which caused a somatoform pain disorder and permanent disability. This is one of the NHS’s 10 “never events.”
£2 million made up of compensation for the injury, past and future loss of earnings, care and equipment , treatment and the additional cost of suitable housing.
Compensation For Poor Surgical Care During Surgery to Remove Tumour in Salivary Glands
A clinical negligence claim brought by the Claimant for damages following substandard surgical care during a surgery to remove a tumour called a pleomorphic adenoma in 1994. The Claimant claimed for the failure to advise of the risks of surgery, allowing her to make an informed decision. Secondly, she claimed for the failure by the Defendant to perform an open surgery which would have allowed for complete removal of the tumour.
The claim settled at mediation for £425,000.