Gastric Inlet Spot Ablation: Advancing Toward Precision Medicine's Era of “Treating the Right Patient”—The “Pro-Intestinal Microenvironment Hub” Hypothesis Based on Functional Activity

This letter comments on a recent study examining the heterogeneous and sometimes unsustained efficacy of gastric inlet patch (GIP) ablation.To address this clinical puzzle, we propose the conceptual framework of the GIP as a functionally active "foregut microenvironment hub."Its variable secretory profile (e.g., pepsin, cytokines) likely underlies differences in both symptom generation and treatment response.We argue that advancing therapeutic strategy from the question of "whether to ablate" to "for whom to ablate" is essential.Future approaches should incorporate functional activity assessment of this hub to stratify patients, thereby ushering in an era of precision management for GIP-related symptoms.