Histotripsy for selected gastrointestinal liver metastases: Current evidence, patient selection and responsible adoption

Histotripsy is an emerging non-invasive focused-ultrasound therapy that mechanically fractionates tissue through acoustic cavitation without heat, ionizing radiation or needle placement.For gastrointestinal liver metastases, its potential clinical role lies in selected ultrasound-visible and acoustically accessible lesions that are difficult to treat safely with resection, thermal ablation or radiation.This review evaluates the mechanism, clinical evidence, patient selection, imaging response, immunobiology, safety, competing liverdirected strategies, cost considerations and responsible adoption of histotripsy for gastrointestinal liver metastases.A structured literature search of PubMed/MEDLINE and Scopus was performed from database inception to June 21, 2026, supplemented by reference-list screening, clinical trial registries, regulatory sources and health technology assessment material.Inclusion criteria were studies on the use of histotripsy for liver tumors reporting on any one or combination of the following: Biologic rationale, immune effects, feasibility, technical success, safety, treatment response and/or clinical outcomes.Exclusion criteria were non-English articles and conference abstracts.Current evidence supports feasibility, technical success and encouraging short-term safety, but remains limited by mixed tumor cohorts, short follow-up, evolving imaging interpretation, incomplete post-market denominator data and absence of randomized comparative trials.Histotripsy should therefore be viewed as a selective adjunct within multidisciplinary liver-directed care rather than as a replacement for surgery, thermal ablation, stereotactic body radiation therapy, arterial therapy or systemic treatment.