Effect of the Time of Day on the Success and Adverse Events of ERCP

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.

Design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: Patients with no previous papillary intervention who underwent ERCP at our institution between November 2006 and November 2008.

Main Outcome Measurements: 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.

Limitations: 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.