ERCP is usually the technique of choice to solve biliary obstruction due to its minimally invasive nature. Patients and medical staff have high expectations in the procedure. However, when ERCP fails, patients, their relatives and the doctors in charge might experience some frustration that can be transferred to the endoscopist. Besides, the limit between a failed ERCP with or without complications is very narrow. The psychological response of the endoscopist following a failed ERCP is very poorly studied.


      To study the possible negative psychological impact on the endoscopist that failure of biliary drainage by means of ERCP may have.


      Members of the Spanish Society for Gastrointestinal Endoscopy, registered at institutions offering ERCP were sent a questionnaire about the way in which ERCP failure usually affects them. Some modified items from the Hamilton Depresion Rating Scale (HDRS) [1], frequently used in Psychiatry, were employed. Self-reported data were pooled for analysis.


      123 endoscopists from across Spain participated in the study. There were 76 or 62% in tertiary referral centers and 47 or 38% in community hospitals. In general, after a failed ERCP 36.5% experienced frequently some decrease in self-esteem. In 44% appeared often feelings of guilt and self-reproach. The usual thoughts for taking the blame were having had a lack of technique, not having carefully studied the image tests or not having been more cautious about indications. 16% experienced sometimes difficulty in falling asleep and they complained of being restless and disturbed during the night. 38% experienced some worry and fear that any complication may arise. 23.5% had from time to time tension and irritability. They also complained slowness of thought and restlessness associated with some kind of anxiety. 44% suffered oftentimes from rumination thinking and their thoughts were repetitively over the failed ERCP. For most endoscopists (82%), what was learned from a failed ERCP was more important than the trouble of failure. 62% claimed that subsequent scheduled procedures after the failed ERCP may be affected. No statistically significant differences were found among either endoscopists working in tertiary or community centers.


      It appears that ERCP is a highly demanding procedure both technically and psychologically. In our study, up to 34% of endoscopists may suffer from some kind of negative psychological feeling after a failed procedure, although for most of them, every failed ERCP is mainly used in order to improve success in the next. No significant differences between physicians working in large or small centers were found.
      [1] Hamilton, M., Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6:278