Malpractice actions arising from gastrointestinal endoscopic care most frequently allege improper performance of the procedure and errors in diagnosis. Virtually all claims alleging an iatrogenic injury involve perforation, which in principle should be defensible if proper informed consent is documented. Allegations of errors in diagnosis primarily pertain to missed colon cancer. The relative malpractice claim risk of sigmoidoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy are similar. This article summarizes the basic elements of a malpractice suit, the recent history of medical malpractice, and the relationships between iatrogenic patient injury and malpractice suits. The allegations in malpractice claims against endoscopists are examined.