Introduction: Barrett’s esophagus high-grade dysplasia (BE HGD) can transform into esophageal adenocarcinoma (EAC) in 19-28% of the cases. Once resected, a shift in diagnosis from HGD to EAC happens in 21-38%. Calcium electroporation combines a local injection of calcium with electrical pulses to increase the individual cells’ permeability and flux of ions leading to necrosis. This study presents the first results with calcium electroporation in the esophagus.

Methods: Six patients with BE HGD scheduled for an endoscopic submucosal dissection (ESD) were treated with Ca-EP 6 weeks before the planned ESD. All side effects and adverse events (AEs) were registered, and the patients were later evaluated with gastroscopy.

Results: The observed adverse events included retrosternal pain, throat irritation, coughing, and headache. No serious adverse events were observed. A hyperemic area was seen in 4 patients after Ca-EP corresponding to treated areas. A fibrinous coating (3 patients) and ulcers (4 patients) were observed in the esophagus up to a week after treatment. One patient had to undergo 2 CTA scans after treatment due to pain and a visually large fibrinous clot, which showed no signs of perforation.

Conclusion: Ca-EP is safe and feasible in patients with BE HGD. This study paves the way for more extensive studies to investigate the effect on dysplasia cells and the safety and feasibility of treating esophageal adenocarcinoma.