Calcium electroporation for palliation of colorectal cancer

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Aims Electroporation (ePORE) involves the application of electrical pulses on tumours via an electrode (EndoVE, Mirai Medical), to create pores on cancer cells and allow entry of cytotoxic agents, leading to malignant cell destruction. ePORE may reduce tumour-related bleeding and shrink tumours. We sought to assess the efficacy of the modality in our Hospital Practice (North Tees&Hartlepool NHS Foundation Trust, UK). Methods We applied ePORE to 3 patients with symptomatic, incurable colorectal cancers, not candidates for other palliative treatments. All patients had rectal bleeding; the third patient also had urgency/tenesmus. The 1 st and 3 rd patients’ tumours were rectal; the 2 nd patient had a sigmoid colon primary. All patients had enema preparation. Treatment was delivered by flexi-sigmoidoscopy and EndoVE electrodes. Two patients received sedation; one had an unsedated procedure. Procedures were performed by 2 operators. Calcium-gluconate 10% was injected in the tumours, followed by ePORE. The 1 st patient received 2 sessions, on days 1 (10ml of calcium) and 98 (8ml of calcium), whilst 2 patients only underwent one session (10ml and 7ml of calcium, respectively). All patients had check-sigmoidoscopy and symptoms review on week-8. The 1st patient’s tumour was further assessed 98 days after the initial procedure, when a second ePORE session was delivered. Results All procedures were uneventful, with no peri-procedural complications such as arrhythmias or significant bleeding; patients only experienced mild intraprocedural discomfort. All patients reported significant improvement in bleeding after their first session. The 1 st patient experienced complete bleeding cessation; the 2 nd and 3 rd patients reported mild residual bleeding. The 3 rd patient reported resolution of tenesmus. Macroscopically, the 1 st patient’s tumour appeared approximately 50% smaller following their first session. The 2 nd patient’s tumour appeared endoscopically unchanged following their session, despite symptoms improvement. The 3 rd patient’s tumour appeared approximately 70% smaller following their session. On follow-up, the 1 st patient did not have any cancer-related admissions following electroporation; he unfortunately passed away 8 months after his first session, with urosepsis. The 2 nd patient’s anaemia resolved; he has had no cancer-related hospital interactions and remains bleeding-free. The 3rd patient had no cancer-related admissions; he passed away 10 months later, due to pulmonary fibrosis and recurrent haematuria [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Conclusions In our case series, electroporation (ePORE) proved a safe, well-tolerated and clinically and endoscopically efficient palliation modality. Further case analyses are required to see if these benefits are reproducible on a wider scale. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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