Post written by Joseph C. Anderson, MD, from the Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, and the New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA.

The goal of our study was to examine the risk of metachronous large serrated polyps (SPs) and advanced adenomas in patients with 5- to 9-mm proximal HPs.

Since data on metachronous risk for patients with index proximal 5- to 9-mm hyperplastic polyps (HPs) are limited, the clinical significance of these polyps is unclear. Conversely, published data suggest that sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs), and large (> 1 cm) hyperplastic polyps (HPs) are high-risk lesions requiring close surveillance. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the risk of metachronous large serrated polyps (SPs) and advanced adenomas in patients with 5- to 9-mm proximal HPs.

8560 NHCR participants were included (44.8% women, average age 59.0 years, SD 9.1). Similar to those with large HPs or any SSPs/TSAs at index exam (OR = 7.63; 95% CI: 4.78-12.20), individuals with proximal 5- to 9-mm HPs had an elevated risk for metachronous large SPs (OR = 4.77; 95% CI: 2.54-8.94) as compared to adults with low-risk conventional adenomas.

In summary, we observed that 5- to 9-mm HPs proximal to the sigmoid on index exam were associated with an increased risk for future large SPs, while non-significant HPs were associated with a lower risk. These data provide strong evidence to support shorter surveillance intervals for individuals with 5- to 9-mm proximal HPs than for patients with only non-significant HPs. An expert panel has recommended 5-year follow-up for individuals with these lesions. Our outcome of metachronous large serrated polyps, although supported by other studies, should still be validated in other populations in order to clarify the appropriate follow-up for individuals with index serrated polyps.

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