ERCP Procedure Injury Claims

What is an ERCP procedure?

To understand where errors can occur, it is helpful to first understand what the procedure involves. ERCP stands for Endoscopic Retrograde Cholangiopancreatography. It is a specialised technique that combines the use of an endoscope (a flexible camera tube) and X-rays.

What ERCP is used for

Doctors generally use this procedure to treat problems in the "drainage pipes" of your digestive system. It is specifically designed to diagnose and treat conditions affecting:

• The bile ducts: The tubes that carry bile from the liver.
• The gallbladder: Often to remove stones that have become stuck.
• The pancreas: To investigate narrowing or blockages in the pancreatic duct.

What happens during ERCP

The procedure is complex and is usually carried out by a specialist Consultant Gastroenterologist or a senior registrar under supervision. Here is a simple breakdown of the process:

• Sedation: You are usually given a sedative (medicine to make you sleepy) and a throat spray to numb the area. In some cases, general anaesthetic is used.
• Insertion: The doctor guides the endoscope through your mouth, down your food pipe (oesophagus), through the stomach, and into the top part of the small bowel (duodenum).
• Cannulation: This is the technically difficult part. The doctor locates the opening where the bile and pancreatic ducts empty into the bowel (the papilla). They pass a small plastic tube (cannula) through the scope and into the duct.
• Contrast Dye and X-rays: Dye is injected through the tube so the ducts show up clearly on X-ray screens.
• Treatment: If stones are found, the doctor may cut the muscle at the opening to remove them. If there is a blockage or narrowing, they may insert a plastic or metal tube called a stent to keep the duct open.

Alternatives that may be considered

Because ERCP is invasive and carries risks, it is generally reserved for treatment rather than just diagnosis. If a doctor simply needs to see what is happening, safer alternatives should often be used first:

• MRCP (Magnetic Resonance Cholangiopancreatography): An MRI scan that provides detailed images of the bile ducts without entering the body.
• Endoscopic Ultrasound (EUS): Uses sound waves to create images.
• Standard Ultrasound or CT Scans: Used for general abdominal checks.

If an ERCP was performed purely for diagnostic reasons when a safer MRCP could have been used, and an injury occurred, this may be a highly relevant factor in a negligence investigation.

When ERCP leads to serious complications

While minor side effects like a sore throat are common, ERCP has a higher rate of serious complications than a standard gastroscopy. The complexity of working near the pancreas means that things can go wrong, even in experienced hands. However, how these complications are managed often determines the outcome for the patient.

Common serious complications include:

• Pancreatitis: This is the most common serious risk. It occurs when the pancreas becomes irritated and inflamed by the dye or the physical trauma of the instruments. While often mild, severe post-ERCP pancreatitis can be life-threatening and require weeks in hospital.
• Perforation: This is a puncture or tear in the wall of the bowel or the ducts. It is a medical emergency. If not spotted immediately, leakage from the bowel can cause severe infection and sepsis.
• Bleeding (Haemorrhage): This can happen if the doctor cuts the opening of the duct to remove a stone. Delayed bleeding can sometimes occur days after the procedure.
• Infection: If bile does not drain properly after the procedure, or if equipment was not sterile, serious bacterial infection can occur.
• Sedation-related complications: Issues with breathing or heart rate caused by the sedative drugs or anaesthesia.
• Stent-related problems: Stents can move out of place or become blocked, requiring further procedures to be fixed.
• Rare but severe outcomes: In the most serious cases, patients may require admission to the Intensive Care Unit (ICU), emergency surgery to repair a tear, or may suffer long-term health consequences.

Symptoms to take seriously after ERCP

Patients are usually monitored for a few hours after the procedure. However, some complications do not show symptoms immediately. It is vital that patients know what to look for once they are discharged home.

• Severe abdominal pain: Pain that is getting worse rather than better, particularly if it spreads to the back or chest.
• A rigid or hard tummy: This can be a sign of perforation.
• Fever or shivering: High temperature or chills usually indicate infection.
• Vomiting: Particularly if it contains blood or looks like coffee grounds.
• Black or tarry stools: A sign of internal bleeding.
• Jaundice: Yellowing of the skin or whites of the eyes.

How ERCP complications are identified and treated

When a patient complains of severe pain after an ERCP, medical staff have a duty to investigate immediately. They should not simply assume it is "trapped wind" or normal post-operative discomfort.

Typical tests include:

• Blood tests: Specifically checking for elevated white blood cells (infection), haemoglobin drops (bleeding), and most importantly, amylase or lipase levels (markers for pancreatitis).
• CT Scan: This is the "gold standard" for identifying a perforation or an abscess.
• X-rays: To check for "free air" in the abdomen, which suggests a hole in the bowel.

Typical treatments involve:

• Conservative care: For mild pancreatitis or very small perforations, the patient is not allowed to eat or drink. They are given intravenous fluids (drip), strong painkillers, and antibiotics.
• Endoscopic repair: Placing a clip or stent to seal a leak.
• Surgery: If there is a large perforation or severe bleeding, open surgery may be required to repair the damage and wash out the abdomen.

Before leaving the hospital, you should have been given clear instructions about what to watch out for. If you were not told these things, or you were sent home while still in severe pain, the standard of care may have fallen below what is acceptable.

When ERCP harm may raise clinical negligence concerns

Not every bad outcome is due to negligence. Medicine is complex, and complications can happen even with the best care. However, a claim may arise if the care provided was substandard and directly caused your injury.

We often investigate the following areas in ERCP claims:

• Consent and risk disclosure: Did the doctor clearly explain the risks before the procedure? Were you told about safer alternatives like MRCP? If you had known the risks, would you have declined the procedure?
• Whether ERCP was clinically indicated: Was the procedure actually necessary? Performing a risky ERCP for vague symptoms when a scan would have sufficed is a common area of concern.
• Technical performance: While accidents happen, some injuries are caused by incompetence or lack of skill, such as using excessive force with the endoscope or cutting in the wrong direction during a sphincterotomy (the process of making a small cut in the muscle ring located at the opening of the bile duct).
• Monitoring and escalation: Did the nursing staff or junior doctors miss the signs of deterioration? Was there a delay in calling the Consultant when your blood pressure dropped or pain increased?
• Premature discharge: Being sent home too early, particularly if blood tests showed rising infection markers or inflammation.
• Follow-up failures: Sometimes stents are put in temporarily but the hospital fails to arrange an appointment to take them out. A forgotten stent can become blocked and cause severe, life-threatening infections months later.
• Infection control: Failures in cleaning the endoscopes between patients, leading to cross-infection.

What must be proven in an ERCP clinical negligence claim

In Irish law, proving medical negligence is a rigorous process. It is not enough to show that the surgery went wrong. We must prove that the error should not have happened.

To succeed in a claim, we must establish four key elements:

1. Duty of Care: The medical team owed you a duty to look after your health (this is automatic in doctor-patient relationships).
2. Breach of Duty: We must prove that the care you received fell below the standard expected of a reasonably competent medical professional. This is often called the "Dunne principles."
3. Causation: We must prove that the negligence caused your injury. For example, if you had a perforation, but it was fixed immediately and you recovered fully in a week, there may be negligence but limited "damage." Conversely, if a delay in diagnosis led to sepsis and a 6-month recovery, causation is clear.
4. Damage: The physical, psychological, and financial harm you suffered.

The evidence that often matter most in ERCP cases

Building a case requires a forensic examination of your medical file. At Michael Boylan LLP, our team knows exactly what to look for in the paperwork.

Key documents include:

• Consent form: Does it list the specific complication you suffered? Was it signed on the day of the procedure (under pressure) or in a calm environment beforehand?
• Endoscopy report: This technical report details exactly what happened during the procedure, how long it took, and if any difficulties were noted at the time.
• Radiology images: The X-rays taken during the ERCP can sometimes show if the dye leaked out of the duct, indicating a perforation happened during the procedure.
• Nursing notes and observation charts: These are vital. They show your heart rate, temperature, and pain scores. If your pulse was racing and you were in agony, but the notes say "patient comfortable," there is a discrepancy to investigate.
• Discharge summary: What were you told upon leaving?
• Timeline of events: Your own recollection of when pain started, when you rang the hospital, and when you were seen is crucial evidence.

In addition to these documents, we must obtain reports from independent experts,usually Consultant Gastroenterologists from the UK or further afield,who will review your medical notes. They must confirm that the treatment you received was something no competent doctor of the same status would have done.

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Time limits and process for clinical negligence in Ireland

If you are considering a claim, it is vital to act quickly due to the strict time limits imposed by Irish law. Generally, under the Statute of Limitations, you have two years to issue legal proceedings.

While this "clock" usually starts ticking on the date the injury occurred, medical cases can be complicated because you may not immediately know that an error happened. In these situations, the two-year period may start from the "date of knowledge",the date you first realised, or reasonably should have realised, that your injury was significant and potentially caused by medical negligence. Because determining this date is legally complex, you should never assume you have extra time without confirming it with a solicitor.

There are also special exceptions to the standard time limits:

• If the injured patient is a child, the two-year limit does not begin to run until they turn 18.
• Similarly, if a patient lacks the mental capacity to manage their own affairs,for example, due to a severe brain injury or coma,the time limits may be suspended indefinitely. In the tragic event of a fatal claim, the family generally has two years from the date of death to bring proceedings.

Given these variations, getting early, tailored advice is the safest approach to protect your rights.

Practical steps if you are concerned about ERCP care

If you are currently suffering or are unhappy with the explanations given by the hospital, here are practical steps you can take:

• Seek medical assessment first: Your health is the priority. If you have ongoing pain, fever, or dietary issues, see your GP or a specialist immediately.
• Keep a diary: Write down a simple timeline. Include dates of admission, names of doctors you spoke to, and what was said. Note down the severity of your symptoms day-by-day.
• Request your records: You have a legal right to your medical file under Data Protection/GDPR laws and the Freedom of Information Act (for public patients). You should ask for the "complete clinical file, including endoscopy reports and nursing notes."
• Consider the complaints process: You can make a formal complaint to the hospital or the HSE.
• Seek legal advice: Contact a specialist medical negligence solicitor. We can help you interpret the records and determine if an expert review is necessary.

How Michael Boylan LLP can assist

Medical negligence is a highly niche area of law. It requires a solicitor who understands both the legal landscape and the medical reality.

• Specialist Focus: We are one of Ireland’s leading firms dedicated to medical negligence litigation. We do not dabble in other areas; this is what we do.
• Investigation Strategy: We will take up your medical records and have them organised and paginated. We then instruct top-tier independent experts to provide an opinion on liability (fault) and causation.
• Empathy and Clarity: We know you are dealing with trauma. Our approach is supportive and transparent. We explain every step of the process in plain English, avoiding legal jargon so you always know where you stand.
• Expertise: Our team has successfully managed complex gastroenterology and surgical claims, securing settlements that provide for future care, loss of earnings, and rehabilitation.

ERCP Procedure Injury FAQs

Can ERCP complications happen even with appropriate care?

Yes. ERCP is a high-risk procedure. Complications like pancreatitis can occur even when the doctor does everything correctly. A legal case usually arises only if the doctor made an avoidable error, failed to obtain proper consent, or failed to spot and treat the complication quickly enough.

How soon do pancreatitis or perforation symptoms usually appear?

Symptoms often appear within a few hours of the procedure. However, some perforations or slow bleeds may not present severe symptoms for 24 to 48 hours. If you feel unwell days after discharge, you must seek medical help immediately.

What documents should I request from the hospital?

You should request your complete medical chart. Specifically, ask for the handwritten clinical notes, the nursing observation charts, the operation/endoscopy report, the consent form, and any discharge letters.

Does it matter if ERCP was performed in a private hospital versus the public system?

The medical standards are the same in both. However, who acts as the defendant may differ (e.g., the HSE vs. a private consultant's insurance/indemnity provider). We handle claims against both public (HSE) hospitals and private clinics.

What is the “date of knowledge” in Irish clinical negligence?

This is the date you first realised that your injury was serious and was likely caused by the medical treatment. It is not always the date of the surgery. Establishing this date is critical for the Statute of Limitations, and you should discuss this specifically with a solicitor.

Do medical negligence cases go through the Injuries Resolution Board?

No. The Injuries Resolution Board (formerly PIAB) handles personal injury claims like road traffic accidents. They generally decline to deal with medical negligence cases because the cases involve complex questions of liability. These cases are managed through the legal system.

What if my symptoms were dismissed after discharge and I had to re-attend?

This is a common ground for claims. If you contacted the hospital or GP with "red flag" symptoms and were told to "wait and see" or take paracetamol, and this delay caused your condition to worsen (e.g., a perforation becoming sepsis), there may be a case for negligent follow-up care.

What if the main issue was lack of consent or lack of warning about risks?

If you were not warned about serious risks like perforation, and you can prove that you would not have gone ahead with the procedure had you known, you may have a claim based on lack of informed consent. This is particularly relevant if the ERCP was optional rather than an emergency.

Speak to our specialist team

If you or a family member has suffered a life-changing injury following an ERCP procedure, you need to know if it could have been prevented. We are here to help you find those answers.

Contact Michael Boylan LLP today for a confidential, sensitive discussion about your experience. We will listen to your story and provide expert guidance on your options.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.