title: Effect of the time of day on the success and adverse events of ERCP.
abstract: BACKGROUND
  Physician fatigue and decreased concentration have been proposed as causes of lower completion and adenoma detection rates in afternoon colonoscopies compared with morning colonoscopies. ERCP is a technically demanding and highly operator-dependent procedure, and its success may similarly be affected in the afternoon compared with the morning.
  
  
  OBJECTIVE
  To compare cannulation success and adverse events between ERCP procedures performed in the morning and afternoon.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients with no previous papillary intervention who underwent ERCP at our institution between November 2006 and November 2008.
  
  
  METHODS
  Cannulation success, procedure completion rates, length of procedures, and adverse events.
  
  
  RESULTS
  A total of 296 patients were studied; 114 patients (38.5%) underwent a procedure in the morning and 182 patients (61.5%) underwent a procedure in the afternoon. There were 139 male patients (47.0%). The mean patient age was 59.1 years. The deep cannulation success rate was 95.3% overall, with similar rates when performed in the morning (98.3%) and afternoon (94.0%) (P = .08). When the start time was evaluated as a continuous hour-by-hour variable, there was also no significant difference in deep cannulation success rates (P = .30). Procedure completion rates were similar in both groups (morning, 93.9%; 94.0%, afternoon; P = .97). Adverse events (8.8% for morning procedures vs 7.1% for afternoon procedures, P = .61) and length of procedures (40 minutes for morning procedures vs 40 minutes for afternoon procedures, P = .87) were also similar between the 2 groups.
  
  
  CONCLUSIONS
  Small sample size and retrospective study.
  
  
  CONCLUSIONS
  The timing of ERCP, morning versus afternoon, does not seem to affect cannulation success, procedure completion rates, length of procedures, or adverse events.
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Paresh P
authors.initials: PP
authors.lastname: Mehta
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
authors.forename: John A
authors.initials: JA
authors.lastname: Dumot
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome