Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. Patients and Methods: All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors. Results: Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80–0.89). Conclusion: The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.

Objective. Multiple Asian studies have proved the feasibility of laparoscopic approach for surgical treatment of gastric cancer. The difference between Asian and European patients could limit their application in Europe. We reviewed the literature for European studies comparing open gastrectomy with laparoscopic approach in the treatment of gastric cancer. Method. We searched the keywords gastric cancer and laparoscopy in MEDLINE and EMBASE. We included all studies published between 1990 and 2016 and conducted in Europe. Result. We found 1 randomized and 13 cohort studies which compared laparoscopic with open gastrectomy. We found no mean difference in the number of lymph nodes harvested between laparoscopic and open group (mean difference: -0.49; 95% CI: -2.42; 1.44, p=0.62) and no difference of short-term or long-term mortality (short-term odds ratio: 0.74, p=0.47; long-term odds ratio: 0.65, p=0.11). We found a longer operative time in the laparoscopic group (mean difference: 35.75 minutes, p<0.01) but lesser reoperation rate than the open group (odds ratio: 1.55 p=0.01). Conclusion. European based population studies found results comparable with their Asian counterpart. In the current state of evidence, minimally invasive surgery for gastric cancer is safe and can achieve the same oncological results.

Background: Gastric cancer peritoneal metastasis (GCPM) is a common manifestation of advanced gastric cancer, associated with poor prognosis. Methods: The International Gastric Cancer Association (IGCA) convened a multidisciplinary working group of 42 global experts from 15 countries to develop a total of 13 consensus statements addressing diagnosis, treatment, and research priorities for GCPM. Using ACcurate COnsensus Reporting Document (ACCORD)-compliant methodology, the group conducted systematic literature searches and applied a structured Delphi process with anonymous Likert-scale voting and a ≥70% consensus threshold to generate and refine consensus statements. Results: Consensus was achieved for all 13 statements among the working group during the first Delphi round, with 75–100% of respondents selecting either ‘strongly agree’ or ‘agree’. Coefficient of variation values were ≤0.23. Polling of a broader group of experts (n = 66), which included members of the working group (n = 21), during a GCPM consensus session at the 16th International Gastric Cancer Congress (IGCC) in 2025 demonstrated agreement for 12 of the 13 statements. This broader group of experts, which had greater representation from medical oncologists, did not reach consensus (52% agreement) on best practice for systemic treatment of patients with GCPM, possibly due to the rapidly evolving developments in this field of metastatic gastric cancer. Conclusion: This consensus exercise provides a foundation for globally relevant GCPM management strategies and highlights critical research needed to address significant evidence gaps that will improve patient outcomes.

Summary: Objectives: Delayed gastric emptying (DGE) following esophago-gastrectomy significantly affects quality of life. There is no standardized measurement tool for the impact of treatment for DGE on patient symptoms. This study aimed to assess the use of a novel symptom response questionnaire, registered with the European Organization for Research and Treatment of Cancer (EORTC), to objectively evaluate treatment efficacy in patients with DGE following endoscopic pyloric dilatation (EPD). Methods: A prospective cohort study was conducted over a 6-month period, including consecutive patients with a history of esophageal cancer resection undergoing EPD for DGE. Clinical symptoms and endoscopic findings determined the diagnosis of DGE and thus patient suitability for EPD. The procedure involved the use of a water-based balloon catheter (20 mm diameter) inflated for 2 minutes under direct endoscopic vision. A symptom response questionnaire, developed from selected EORTC items, was administered via telephone consultation at 2- and 4-weeks post-intervention to assess symptom frequency, severity, overall health, and treatment satisfaction. Statistical analyses used descriptive statistics, the Wilcoxon signed-rank test for within-subject comparisons, and the Mann–Whitney U test for between-group differences, with a significance level set at P < 0.05. Results: Fifty-one patients were enrolled, with 50 completing the follow-up. After EPD, a significant reduction in the frequency of the main symptom (assessed over the prior 7 days on a 4-point Likert scale; baseline median score 4 [interquartile ranges (IQR) = 3–4], reduced to 2 [IQR = 1–3] at 2 weeks and sustained at 4 weeks, P < 0.01) and its severity (scored over the prior 7 days on a 0–10 scale; baseline median score 7 [IQR = 6–8], reduced to 2.5 [IQR = 2–3] at 2 weeks and 3 [IQR = 1–4] at 4 weeks, P < 0.01) was observed. Symptoms assessed included dysphagia, regurgitation, reflux, nausea, early satiety, and bloating. At 4 weeks, patients reported a significant improvement in overall health, with the median health scale score increasing from 5 (IQR = 2–8) to 7 (IQR = 5–8) (P < 0.01). The level of satisfaction with the questionnaire process was rated at a median score of 7 (IQR = 7–7) for both happiness and ease of completion on a Likert scale from 1 (lowest) to 7 (highest). Seven patients (14%) required subsequent dilatations within 3 months. These were successfully identified at the 4-week questionnaire, demonstrating a significant increase in symptom frequency and severity compared to the group not requiring further EPD (P < 0.01). Conclusion: The symptom response questionnaire effectively quantified symptom improvement following EPD for DGE, offering a novel, reproduceable approach to evaluate treatment outcomes. The findings support the procedure’s efficacy, with most patients reporting significant relief. Additionally, the questionnaire facilitated the identification of non-responders, guiding timely interventions.