For non-high grade Barrett's esophagus, what is the recommended management approach?

The recommended management approach for non-high grade Barrett's esophagus involves endoscopic surveillance plus reflux management. This approach is grounded in the understanding that non-high grade dysplasia in Barrett's esophagus is associated with a relatively low risk of progression to esophageal cancer. As such, the primary goal is to monitor the condition while managing any underlying gastroesophageal reflux disease (GERD) that may contribute to symptoms and potential complications.

Endoscopic surveillance typically includes regular endoscopic exams with biopsies to monitor for any changes in dysplasia or new lesions. This allows for timely interventions should the pathology change over time. Managing reflux may involve lifestyle modifications, pharmacotherapy with proton pump inhibitors, or other measures to control acid exposure, thereby potentially reducing the risk of progression.

Surgical resection or immediate esophagectomy are more aggressive options warranted for higher grade dysplasia or esophageal cancer and are not indicated in cases of non-high grade Barrett's esophagus. Likewise, endoscopic removal of polyps is not a standard procedure in managing non-high grade Barrett’s unless there are corresponding findings justifying such intervention. Thus, the combination of careful surveillance and reflux management is the optimal and most evidence-based strategy in these cases.