[Fatal complications in endoscopic papillotomy]

Medicolegal investigations for possible malpractice were instituted into the death of three patients (two women, aged 59 and 75 years, one man, aged 81 years) after endoscopic papillotomy. In one case the accusation of malpractice had been made by a relative, in the other two the enquiry had been undertaken because the attending doctors had entered the cause of death as "unexplained" on the death certificate. In one patient oesophageal rupture had occurred; in the other two papillary bleeding, with perforation in one, had taken place. Forensic expert opinion failed to find malpractice as the cause of death. There had been the correct indications for the procedure and the patients had been fully informed. Taking into consideration the possible complications of this procedure, it is important to note that insufficient explanations and inadequate experience of the doctor, as well as insufficient capacity for undertaking an emergency operation, may lead to damages being awarded, especially under civil law.