Artificial intelligence (AI) is increasingly being integrated into gastroenterology, with growing applications in upper gastrointestinal (GI) disease detection, diagnosis, risk stratification, and treatment guidance. We performed a comprehensive literature review of the clinical use of AI in upper GI pathologies, focusing on Barrett’s esophagus, gastroesophageal reflux disease, esophagogastric varices, esophageal cancer, and gastric cancer. A systematic search of PubMed/ MEDLINE, EMBASE, Google Scholar, and the Cochrane Library was conducted from October 2024 through March 2026 using Medical Subject Headings terms and free-text keywords related to AI and upper GI disease. Eligible English-language studies included original research, reviews, systematic reviews, and meta-analyses addressing diagnostic, prognostic, or therapeutic applications of AI. Across disease states, AI demonstrated strong performance in image recognition, endoscopic lesion detection, histopathologic interpretation, bleeding risk prediction, and automated clinical decision support. In several studies, AI systems matched or outperformed general endoscopists in detecting Barrett’s-related dysplasia, grading reflux esophagitis, identifying and risk-stratifying varices, and recognizing early esophageal and gastric neoplasia. Emerging multimodal and radiomics-based models also showed promise for noninvasive screening and treatment response prediction. Despite encouraging results, most studies remain retrospective and heterogeneous. Prospective multicenter validation, regulatory oversight, and ethical safeguards are needed before widespread clinical implementation.
BACKGROUND Alpha-fetoprotein (AFP) is an oncofetal protein present at high concentrations during fetal life and subsequently replaced by albumin. Serum AFP levels remain very low throughout adulthood life without malignancy, but may become elevated in individuals with pregnancy, viral hepatitis, active liver injury, cirrhosis, germ cell tumors, or hepatocellular carcinoma (HCC). CASE SUMMARY In this descriptive case series, we present 6 patients with mild, persistent, and stable AFP elevation in the absence of active liver injury, advanced fibrosis (or cirrhosis), or neoplasms, with a mean follow-up of 48 months in our liver clinic. None of the 6 cases had identifiable causes or a diagnosis of viral hepatitis, cirrhosis, or HCC. AFP elevation was relatively mild and stable throughout follow-up, liver function tests remained normal, and no patient developed active liver injury or malignancy, including HCC. We summarize their presentations and prognoses and review the related literature. CONCLUSION These six cases represent an uncommon clinical presentation of AFP elevation characterized by mild, persistent, and stable elevation in the absence of active liver injury, advanced hepatic fibrosis (or cirrhosis), and neoplasms. The prognosis in this case series was excellent: No patient had a doubling of AFP from baseline, and none developed malignancy. This descriptive case series suggests that comprehensive evaluation and regular follow-up remain necessary in this clinical scenario until larger cohort studies confirm its benign course and outcome.
BACKGROUND Primary renal carcinoid tumors (PRCTs) are rare well-differentiated neuroendocrine neoplasms of the urogenital system, though neuroendocrine tumors predominantly arise within the gastrointestinal tract. PRCTs are particularly rare, with approximately 100 cases reported since the first documented case in 1966. Horseshoe kidney represents a well-recognized congenital anatomical risk factor for PRCT. Constipation as a predominant presenting symptom of PRCT is highly atypical and has seldom been described in previous literature. CASE SUMMARY A 30-year-old female patient presented with a one-year history of left-lower abdominal distension and chronic constipation. Incidental imaging revealed a left-sided renal mass in a horseshoe kidney with fused lower renal poles. Computed tomography urography further characterized it as a 5.6 cm × 4.7 cm soft-tissue mass in the mid-lower portion of the left kidney containing central necrotic changes. Preoperative staging work-up, including chest computed tomography and abdominal-pelvic imaging, excluded distant metastatic lesions. Laparoscopic left radical nephrectomy was performed. Postoperative pathological examination confirmed a PRCT, pT2aN0M0. Immunohistochemistry revealed focal chromogranin-A positivity and diffuse synaptophysin and vimentin positivity. The patient’s constipation and abdominal distension completely resolved at 4 weeks after surgery. Although serum neuroendocrine marker levels were not obtained before surgery, 12-month postoperative surveillance computed tomography revealed no evidence of tumor recurrence or metastasis. CONCLUSION PRCTs should be included in the differential diagnosis for renal masses occurring in patients with a horseshoe kidney. Atypical gastrointestinal symptoms such as refractory constipation may represent a clinical clue for this rare neoplasm. Definitive diagnosis relies on comprehensive pathological and immunohistochemical evaluation together with the exclusion of extrarenal neuroendocrine primary lesions.
BACKGROUND Progressive focal muscle wasting in adolescents may result from motor neuron, peripheral nerve, spinal cord, or muscular disorders. Atypical distribution and subsequent recovery can complicate diagnosis. CASE SUMMARY The patient initially developed pain in the left posterior leg musculature, followed by marked muscle wasting. Involvement subsequently extended to the left upper limb, particularly the biceps, and later progressed more mildly on the right side. At its worst, the illness caused significant functional impairment requiring a walking stick. Marked sensory loss was reported in the affected left limb, with reduced or absent reflexes early in the course. Magnetic resonance imaging of the cervical, thoracic, and lumbar spine revealed no clear structural cause. Following symptomatic management, substantial recovery occurred over the subsequent years, with near normal strength and reflexes and no meaningful functional limitations. However, asymmetric muscle wasting persisted, most prominently in the left calf and upper limb. CONCLUSION This case highlights an unusual adolescent-onset neurological syndrome characterized by progressive asymmetric muscle wasting, motor and sensory involvement, severe functional impairment, and substantial recovery with residual atrophy. The atypical distribution and clinical course do not fit neatly into a single classical neurological entity, warranting consideration of an atypical-spectrum presentation of Parsonage Turner syndrome (neuralgic amyotrophy).
BACKGROUND Nasal leech infestation is an uncommon but clinically important cause of unilateral epistaxis, particularly in rural and endemic regions. Because symptoms may be nonspecific and leech saliva contains anticoagulant and anesthetic substances, diagnosis may be delayed. AIM To retrospectively analyze the clinical characteristics, environmental exposure history, seasonal distribution, management strategies, and immediate outcomes of patients with nasal leech infestation, with the aim of improving clinical awareness, early diagnosis, and timely treatment of this uncommon cause of unilateral epistaxis in rural and endemic regions. METHODS We conducted a retrospective single-center case series of patients diagnosed with nasal leech infestation at the otorhinolaryngology outpatient clinic of our hospital between April 1, 2021 and April 1, 2026. Demographic characteristics, environmental exposure history, clinical presentation, seasonal distribution of presentations, management, and immediate outcomes were retrospectively analyzed. RESULTS A total of 38 patients were included. Of these, 25 patients were aged ≤ 14 years. All patients lived in mountainous or peri-mountainous rural areas and had a history of exposure to untreated natural water sources or humid outdoor environments. Presentations clustered in summer and early autumn, especially in August and September. The most common symptom was unilateral epistaxis, followed by direct visualization of a leech and nasal foreign body sensation. All leeches were removed during the initial outpatient visit under anterior rhinoscopy or nasal endoscopic guidance using forceps, following topical anesthesia. No patient required general anesthesia, blood transfusion, or hospital admission. CONCLUSION Nasal leech infestation should be considered in patients with persistent unilateral epistaxis, especially in endemic rural areas and in patients with recent freshwater exposure. Careful endoscopic examination facilitates diagnosis and immediate removal. Further prospective studies are needed to evaluate long-term outcomes and optimal removal techniques.
