Consulting in quality and safety in GI endoscopy, especially ERCP

Home of Fred the Snake (and Dr. Peter)

Do you have an ERCP service? Is it safe? Have you been sued yet?

Most hospitals of any size offer ERCP (Endoscopic Retrograde CholangioPancreatography) because it is important for some patients, but it also has significant down-stream effects, bringing in complex pancreatic and biliary patients who need extensive investigations and often major surgery.

ERCP procedures are usually performed by medical Gastroenterologists. It is the most risky procedure that many do on a regular basis. Adverse events occur in at least 5% of cases, and about 1% are life-threatening. Adverse events are inevitable, but (successful) lawsuits are not. The main reasons why claims are made is well known, and they should be relatively easy to prevent.

Surgical Excellence has an unique resource in this context. Dr. Peter Cotton is well known throughout the world as a pioneer and expert in ERCP (he actually named it over 40 years ago), and has been at the forefront of efforts to improve quality and safety in digestive endoscopy, and of ERCP in particular. He  “wrote the book” on ERCP (1) has chaired national consensus conferences on definitions of adverse events (2) and procedural complexity, promoted quality and accountability in endoscopy (3), and written a recent editorial emphasizing concern about some current practices (4). He is very familiar why ERCP-related lawsuits occur, having acted as an expert witness in over 100 cases.

Under Dr. Cotton’s direction, Surgical Excellence offers a consulting service to hospitals wishing to improve the quality and safety of ERCP services, and to reduce the risk of expensive litigation. 

1. Cotton PB, Leung JWCAdvanced Digestive Endoscopy; ERCP.  Blackwell Scientific Publications, 2006.

2. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, et al.  A lexicon for endoscopic adverse events:  report of an ASGE workshop.  GIE 2010 Mar; 72(3):446-54.

3. Cotton PB. Quality endoscopists and quality endoscopy units. J Intervent Gastroenterology 2011; 1: 83-874. Cotton PB. Are low-volume ERCPists a problem in USA? GIE 2011; 74:161-6