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Gastric cancer (GC) remains a leading cause of cancer-related morbidity and mortality worldwide, particularly in East Asia. Nanomedicine has emerged as a promising strategy to enhance the precision and efficacy of GC diagnosis and therapy. This study aimed to systematically evaluate global research trends and knowledge structures in GC nanomedicine during the early 21st century using bibliometric and visualization analyses. Relevant publications during the early 21st century were retrieved from the Web of Science Core Collection (WoSCC) and analyzed using R, VOSviewer, CiteSpace, Scimago Graphica, and Pajek. The included records spanned 2003-2026, with the two items labeled "2026" reflecting early access articles already indexed in WoSCC at the time of data retrieval. A total of 1,717 publications authored by 9,857 researchers across 2,192 institutions in 83 countries were included. China, Iran, and the United States were identified as leading contributors, with major research hubs at the Chinese Academy of Sciences, Shanghai Jiao Tong University, and Islamic Azad University. Research output exhibited a sustained upward trend, with citation frequency and H-index steadily increasing. Five primary research hotspots were identified: nano-drug delivery and chemotherapy optimization, targeted therapy and signaling pathway modulation, photothermal/photodynamic synergistic therapies, functionalized nanomaterials for diagnostics, and immunotherapeutic/antibacterial nanomedicine. Over time, the field has evolved from early nanocarrier design (2003-2015) to targeted therapy and diagnostic applications (2015-2020), and more recently toward immunotherapy and green synthesis strategies (2020-2026). Importantly, most studies in this field remain at the preclinical or early translational stage, underscoring the need for further validation using standardized preclinical models and well-designed clinical trials. This bibliometric study provides a comprehensive overview of the developmental trajectory, key contributors, and emerging trends in GC nanomedicine, offering valuable insights to guide future interdisciplinary research, clinical translation, and strategic resource allocation.