To improve detection of esophageal (pre)malignant lesions during surveillance endoscopy of
patients at risk of developing malignancies, for example in Barrett's Esophagus (BE), there
is a need for better endoscopic visualization and the ability for targeted biopsies. Optical
molecular imaging of neoplasia associated biomarkers could form a promising technique to
accommodate this need. It is known that the biomarker Vascular Endothelial Growth Factor
(VEGF) is overexpressed in dysplastic and neoplastic areas in BE segments versus normal
tissue and has proven to be a valid target for molecular imaging. The University Medical
Center Groningen (UMCG) developed a fluorescent tracer by labeling the VEGF-targeting
humanized monoclonal antibody bevacizumab, currently used in anti-cancer therapy, with the
fluorescent dye IRDye800CW. The phase I study, named VICE, completed within the UMCG, showed
that synchronal use of VEGFA-guided near-infrared fluorescence molecular endoscopy (NIR-FME)
and high-definition white light endoscopy (HD-WLE), following topical or systemic tracer
administration, could be practiced to recognize dysplastic and early EAC lesions in patients
with BE. Furthermore, early lesion detection was improved by ~33% using the topically applied
tracer approach compared with HD-WL/NBI endoscopy. With this phase 2 intervention study the
investigators aim to statistically confirm previous pilot (Phase I) clinical data showing
that the combination of HD-WLE and FME using labelled bevacizumab improves early EC detection
over the current clinical standard.