{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:39:02Z","timestamp":1787027942265,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background\/Objectives: Gastric cancer often presents at advanced stages with complications such as iron-deficiency anemia (IDA) due to chronic bleeding, representing a significant global health burden. Palliative management of bleeding tumors in frail patients remains challenging. This study evaluates the feasibility, safety, and efficacy of endoscopic calcium-electroporation (Ca-EP), a novel non-thermal ablation technique, for controlling bleeding in end-stage gastric cancer. Methods: Retrospective case series including consecutive patients with end-stage, bleeding gastric cancer and IDA requiring transfusions. Ca-EP was performed using the EndoVE system, which delivers bipolar electrical pulses (250 kHz) to induce reversible electroporation, enabling calcium influx and tumor cell apoptosis. Primary endpoints were clinical success (hemoglobin stabilization\/reduced transfusions) and safety. Secondary endpoints included tumor regression, procedural time, and hospital stay. Results: Five patients (median age 81 years) were included. Clinical success was achieved in 80% (4\/5) of patients, with reduced transfusion needs and stable hemoglobin levels. One patient required adjunctive hemostatic radiotherapy. No major or minor adverse events were reported, and all patients were discharged within 24 h. Procedural median time was 38 min (range: 22\u201365). Endoscopic follow-up in three patients showed mild tumor regression or stability. Three patients required repeat Ca-EP sessions due to recurrent bleeding. Conclusions: Endoscopic Ca-EP is a safe, minimally invasive palliative option for bleeding gastric cancer, offering sustained hemostasis and potential antitumor effects without systemic toxicity. Its feasibility in frail patients underscores its clinical relevance, though larger prospective studies are needed to optimize parameters and validate long-term outcomes.<\/jats:p>","DOI":"10.3390\/diseases13100340","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:06:32Z","timestamp":1760508392000},"page":"340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pioneering Endoscopic Calcium-Electroporation in Gastric Cancer: A Case Series of an Emerging Therapeutic Approach"],"prefix":"10.3390","volume":"13","author":[{"given":"Giuliano Francesco","family":"Bonura","sequence":"first","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Gualandi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Soriani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8793-5890","authenticated-orcid":false,"given":"Pablo","family":"Cortegoso Valdivia","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8457-2994","authenticated-orcid":false,"given":"Tommaso","family":"Gabbani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Zadro","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0952-9635","authenticated-orcid":false,"given":"Federica","family":"Indulti","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Frassanito","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8758-654X","authenticated-orcid":false,"given":"Germana","family":"de Nucci","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, 20024 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Manno","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Azienda USL di Modena, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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