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AIM:To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan.METHODS:A retrospective review of cases tried in the civil court system during the 21-yearperiod from 1985 to 2005, identified in a computerized legal database, was undertaken.RESULTS:Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to esophagogastroduodenoscopy, 4 (22%) to colonoscopy,4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography.Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis.In 10 cases, the patient died of the complications.Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n= 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%).CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.