title: Diagnostic and therapeutic yield is not influenced by the timing of small-bowel enteroscopy: morning versus afternoon.
abstract: BACKGROUND
  Small-bowel enteroscopies (BEs) are tedious and prolonged, and their efficacy may be affected by the timing of procedures.
  
  
  OBJECTIVE
  We aimed to evaluate the differences in diagnostic yield, insertion depth, procedure duration, therapeutic yield, and adverse events (AEs) of enteroscopies performed in the morning versus the afternoon.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients who underwent BE for suspected small-bowel disease at a single institution between January 2008 and August 2009.
  
  
  METHODS
  Differences in diagnostic yield, insertion depth, procedure duration, therapeutic yield, and AEs between morning (started before noon) and afternoon (after noon) procedures.
  
  
  RESULTS
  A total of 250 enteroscopies were performed on 250 patients, of which 125 patients (50%) underwent a procedure in the morning and 125 patients (50%) underwent the procedure in the afternoon. The diagnostic yield with anterograde enteroscopy was the same in both the morning and afternoon (63.7% and 63.7%, respectively; P = .99). The procedure durations were also similar (42.4 ± 21.5 minutes vs 46.2 ± 22.4 minutes, respectively; P = .25). Similarly the diagnostic yield with retrograde enteroscopy was similar in morning and afternoon (44.1% and 35.3%, respectively; P = .46). However, the procedure durations of retrograde BE were significantly shorter in the morning compared with the afternoon (51.3 ± 21.3 minutes vs 66.6 ± 32.9 minutes, respectively; P = .03). Therapeutic yield and AEs were similar.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  The timing of procedure, morning versus afternoon, did not affect the diagnostic and therapeutic efficacy of BE in patients with suspected small-bowel disease.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH 44195, USA. sanakam@ccf.org
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Bennie R
authors.initials: BR
authors.lastname: Upchurch
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Sabrina
authors.initials: S
authors.lastname: Vannoy
authors.forename: Milan
authors.initials: M
authors.lastname: Dodig
authors.forename: Janice M
authors.initials: JM
authors.lastname: Santisi
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
mesh_terms: D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013995:Time; D013997:Time Factors