Duodenal mucosal ablation by irreversible electroporation: Modulating the gut-liver axis in metabolic steatotic liver disease.

Targeting the gut-liver axis has emerged as a promising strategy in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), a condition that currently represents the most common cause of chronic liver disease worldwide. Within this axis, the duodenum serves not only as a site of nutrient absorption but also as a metabolic sensor capable of influencing systemic and hepatic homeostasis. We have read with great interest the recent study by Yu , investigating the effects of duodenal mucosal ablation (DMA) by irreversible electroporation in a rat model of MASLD. The authors reported remarkable reductions in hepatic lipid content, improvements in serum lipid profiles, and both structural and functional changes in the intestinal mucosa, including alterations in enteroendocrine signaling. These results corroborate the pivotal role of the gut-liver axis in the pathogenesis of MASLD and highlight the potential of minimally invasive approaches targeting the proximal intestine. In this letter, we discuss the broader implications of these findings, emphasizing the translational relevance of intestinal modulation strategies in the comprehensive treatment of MASLD.