There has been a global trend in the reduction of cancer-related mortality, especially in high-income countries [1]. Primary pre- vention, screening programs, minimally invasive therapies, tar- geted chemotherapy, and better palliative treatments can ex- plain, at least in part, this global trend. One of the possible con- sequences of the longer survival of patients with cancer is an in- creased frequency of adverse events related to treatment and the disease itself. Gastrointestinal (GI) bleeding is one of the most common causes of admission to the emergency room of oncology centers. In our experience, the bleeding source is the tumor itself in more than 80 % of patients with a primary malig- nancy located in the upper GI tract [2]. The performance of risk scoring systems in predicting the clinical outcomes of upper GI bleeding from malignancy is unclear. The ideal risk scoring sys- tem should accurately identify low risk patients who could be eligible for early discharge, differentiating them from high risk patients who should be managed in the intensive care unit. “ The authors found that the full Rockall score performed better than Glasgow–Blatchford score and admission Rockall score in patients with bleeding from gastric cancer.” In this issue of Endoscopy, Kim et al. [3] from the National Can- cer Center (Gyeonggi, Korea) report on a retrospective obser- vational study in which they compared the performance of three risk scoring systems in predicting the clinical outcomes of patients with GI bleeding from inoperable gastric cancer. From 2001 to 2015, 781 patients with advanced gastric cancer underwent upper GI endoscopy to investigate suspected GI bleeding; 424 patients were excluded (candidates for curative gastrectomy, 62.7%; incomplete data, 22.9%; and absence of clinical or endoscopic signs of tumor bleeding, 14.4%). The Glasgow–Blatchford score (GBS), admission Rockall score, and full Rockall score were calculated for the 357 included patients, who all had inoperable stage IV disease with unequivocal signs of tumor bleeding. Most patients were males in their 50s, re- ceiving palliative chemotherapy, presenting with anemia and melena, and with a large ulcerated tumor involving more than 50 % of the stomach. Adherent clots (Forrest IIb) were the most common endoscopic finding, but high bleeding risk stigmata (i.e. Forrest Ia, Ib, and IIa) were found in roughly one-third of patients. Urgent hemostatic intervention (endoscopic clipping, injection, spraying hemostatic agents, arterial embolization) was performed in 118 patients (33.1 %), and immediate hemo- stasis was achieved in 108 (93.1%). There was no mention of Predicting clinical outcomes in patients with bleeding from gastric cancer: novel tools are needed to nail it! Referring to Kim YL et al. p. 359–367 Author Fauze Maluf-Filho 1,2,3 Institutions 1 Department of Gastroenterology – Endoscopy Unit, ICESP, University of São Paulo, São Paulo, Brazil 2 Endoscopy Unit, Hospital Beneficencia Portuguesa de São Paulo, São Paulo, Brazil 3 Endoscopy Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil Bibliography DOI https://doi.org/10.1055/a-1129-7578 Endoscopy 2020; 52: 332–333 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Fauze Maluf-Filho, MD, Instituto do Câncer do Estado de São Paulo – ICESP-FMUSP, Av. Dr. Arnaldo, 251, 2° andar Endoscopia, CEP 01246-000, São Paulo – SP, Brazil Fax: +55-11-32565695 fauze.maluf@terra.com.br Fauze Maluf-Filho Editorial 332 Maluf-Filho Fauze. Predicting outcomes in bleeding gastric cancer … Endoscopy 2020; 52: 332–333 Downloaded by: Karolinska Institutet. Copyrighted material.