Effect of the time of day on the success and adverse events of ERCP

Abstract

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. To compare cannulation success and adverse events between ERCP procedures performed in the morning and afternoon. Retrospective cohort study. Tertiary referral center. Patients with no previous papillary intervention who underwent ERCP at our institution between November 2006 and November 2008. Cannulation success, procedure completion rates, length of procedures, and adverse events. 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. Small sample size and retrospective study. The timing of ERCP, morning versus afternoon, does not seem to affect cannulation success, procedure completion rates, length of procedures, or adverse events.