Endoscopic calcium electroporation in patients with precancerous cellular changes in the esophagus

Barrett's esophagus high-grade dysplasia (BE HGD) can transform into esophageal adenocarcinoma (EAC) in 19-28 % of the cases. Calcium electroporation (Ca-EP) is a novel anti-cancer therapy where electrical pulses are combined with a local injection of calcium to increase intracellular calcium levels leading to cell death. Calcium electroporation has shown effect on premalignant conditions, and a relative sparing of normal tissue.

The primary aim of this study was to establish safety with Ca-EP in patients with BE HGD. Six patients with BE HGD scheduled for an endoscopic submucosal dissection (ESD) were treated with Ca-EP six weeks before under general anesthesia in an outpatient setting. All adverse events (AEs) were registered, and patients were evaluated with gastroscopy within one week.

AEs included retrosternal pain, throat irritation, coughing, and headache. No serious adverse events were registered. A hyperemic area was seen in four patients directly after Ca-EP. Fibrinous coatings (four patients) and ulcers (four patients) were observed up to one week after treatment. One patient underwent two CTA scans due to pain and a visually large fibrinous clot. CTA showed no sign of perforation. Six weeks after five patients had a partial visual response with new squamous epithelium. However, all patients still had BE HGD.

Ca-EP was safe in patients with BE HGD. This study paves the way for more extensive studies to investigate the effect on dysplastic cells and its role in treating esophageal adenocarcinoma.