Medical disputes involving lower gastrointestinal endoscopies: cases from the Korean Medical Dispute Mediation and Arbitration Agency

Abstract

Background/aims: As the number of lower gastrointestinal endoscopies and high-risk examinees increases, the incidence of adverse events associated with these endoscopies has also increased. Medical disputes and lawsuits related to adverse events are rapidly increasing.

Methods: Medical disputes related to lower gastrointestinal endoscopy that had been filed in Korean Medical Dispute Mediation and Arbitration Agency (K-medi) from April 2012 to August 2020 were evaluated with the corresponding medical records and written appraisal. Facilities, patients, procedures, adverse events, and outcome-related variables related to medical disputes were analyzed.

Results: As the number of lower gastrointestinal endoscopies in Korea increases each year, the number of medical disputes related to lower gastrointestinal endoscopy appraised by K-medi has also increased yearly during the same period. Among the 121 cases analyzed, 86 (71.1%) were conciliated and 35 (28.9%) were cosigned by prosecution. Perforations accounted for the largest proportion of cases (93 cases, 76.9%). Most patients (n = 119, 98.3%) underwent non-emergent procedures, and only 10 (8.3%) underwent them for therapeutic purposes. Approximately one-fifth of the patients (n = 25, 20.7%) died.

Conclusion: The number of medical disputes related to lower gastrointestinal endoscopy are increasing. To prevent this, it is important to review the data on existing cases and establish specific response guidelines.

Keywords: Colonoscopy; Medical accidents; Medical errors; Medical litigation; Patient safety.

Figure 1

Flowchart of the study.

Figure 2

Distribution of lower gastrointestinal endoscopy cases referred to the K-medi. (A) Annual trends in the number of lower gastrointestinal endoscopy cases referred to the K-medi. (B) Number of lower gastrointestinal endoscopy cases referred to the K-medi by medical institution type. (C) Number of lower gastrointestinal endoscopy cases referred to the K-medi by administrative district. K-medi, Korean Medical Dispute Mediation and Arbitration Agency.

Figure 3

Types of adverse events associated with lower gastrointestinal endoscopy-related medical disputes. (A) Total. (B) Conciliation cases. (C) Cosigned cases.

Figure 4

Severity of perforation in lower gastrointestinal endoscopy-related medical disputes according to patient demographics and procedural factors. (A) By sex. (B) By age group. (C) History of abdominal surgery or radiation therapy. (D) By purpose of procedure. (E) By point of awareness. (F) By perforation site. (G) By cause of perforation.

Figure 5

Differences in perforation characteristics in medical disputes related to lower gastrointestinal endoscopy according to procedural purpose. (A) Point of awareness. (B) Immediate action after perforation. (C) Final management after perforation. (D) Classification of perforation severity.

Figure 6

Classification of perforation severity based on medical disputes related to lower gastrointestinal endoscopy with clipping after biopsy or polypectomy.