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Background and study aims The Varix Trainer model 1 (VTM1) was created for trainees to safely practice basic endoscope manipulation skills. The VTM1 was tested to see if it could distinguish levels of endoscope manipulation skills (construct validity) and whether training with it could improve these skills faster (content validity). Patients and methods We enrolled 23 novice endoscopists, 18 second-year trainees, and 13 expert endoscopists. They were asked to point with the endoscope tip to 20 numbers in the model as quickly as possible using torque, single-hand small/large wheel manipulation (SHSW), and retroflexion techniques. Their mean times (t20) were compared to determine if the model could distinguish different levels of expertise. Subsequently, 14 novices trained for eight short sessions, and the pre-training and post-training t20 were compared. Nine novice endoscopists received no training and were retested after 4 to 6 weeks (controls). Results Experts had faster t20 than second-year trainees, who were faster than novices, for all three techniques ( P < 0.001). After eight sessions, the mean t20 for novices improved from 112 to 66 seconds for torque, 144 to 72 seconds for SHSW, and 108 to 63 seconds for retroflexion, (all P < 0.001). Their t20 were equivalent to second-year trainees. Improvement in t20 was also seen with the control group, but total reduction was less than for the training group. Conclusions The VTM1 distinguished varying levels of expertise for all techniques, suggesting that it is a valid tool for assessing endoscope manipulation skill. A short curriculum improved novices' manipulation skills faster than traditional practice.
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BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is a risk factor for liver cancer. Diabetes, high body mass index (BMI) and old age can all contribute to NAFLD progression. Transient elastography (TE) is used for non-invasive fibrosis assessment. OBJECTIVES: To identify the prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors. MATERIALS AND METHODS: One hundred and forty-one diabetic and 60 normal subjects were screened. Fatty liver was diagnosed when increased hepatic echogenicity and vascular blunting were detected by ultrasonography. Liver stiffness measurement (LSM) representing hepatic fibrosis was assessed by TE. LSM ≥7 kPa was used to define significant hepatic fibrosis. RESULTS: Four cases were excluded due to positive hepatitis B viral markers and failed TE. Diabetic patients had higher BMI, systolic blood pressure, waist circumference and fasting glucose levels than normal subjects. Fatty liver was diagnosed in 82 (60.7%) diabetic patients but in none of the normal group. BMI (OR: 1.31; 95%CI: 1.02-1.69; p=0.038) and alanine aminotransferase (ALT)(OR: 1.14; 95%CI: 1.05-1.23; p=0.002) were associated with NAFLD. Diabetic patients with NAFLD had higher LSM than those without [5.99 (2.4) vs 4.76 (2.7) kPa, p=0.005)]. Significant hepatic fibrosis was more common in diabetic patients than in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. Aspartate aminotransferase (AST)(OR: 1.24; 95%CI: 1.07-1.42; p=0.003) was associated with significant hepatic fibrosis. CONCLUSIONS: Sixty and sixteen percent of diabetic patients were found to have NAFLD and significant hepatic fibrosis. High BMI and ALT levels are the predictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis.