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

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.