Risk of Metachronous Large Serrated Polyps in Patients with 5- to 9-mm Proximal Hyperplastic Polyps

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Data on metachronous risk for patients with index proximal 5- to 9-mm hyperplastic polyps (HPs) is limited. The clinical significance of these polyps is unclear. Data suggested sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs), and large (greater than 1 cm) HPs are high-risk lesions require close surveillance. Data was used from the New Hampshire Colonoscopy Registry (NHCR) was examined for the risk of metachronous large HPs and advanced neoplasms (ANs) in patients with 5- to 9-mm proximal HPs.

Adults with at least 1 polyp resected at index colonoscopy and a surveillance examination 12 months or more after the index were evaluated for the risk for metachronous large (1 cm or greater) SPs and ANs, villous elements, highgrade dysplasia or colorectal cancer (CRC). The risks with proximal 5- to 9-mm HP at index examination were compared with individuals with index findings of large (greater than 1 cm) HPs or any SSPs or TSAs, nonsignificant HPs (less than 1 cm in rectosigmoid, or less than 5 mm anywhere in the colon), high-risk adenomas (As) or greater than 3 adenomas (no SPs), and low-risk adenomas and SPs.

Absolute and adjusted risks of metachronous polyps from a regression model that included age, sex, BMI, smoking, previous polyp history, family history of CRC, year of diagnosis, endoscopist, SP detection rates, and months to surveillance examination were presented.

A total of 8560 NHCR participants were included (44.8% women, average age 59 years, standard deviation 9.1). Similar to those with large HPs or any SSPs/TSAs at index examination (OR 7.63), individuals with proximal 5- to 9-mm HPs had an elevated risk for metachronous large SPs (OR 4.77), as compared with adults with low-risk conventional adenomas.

It was concluded that NHCR data suggested similar to adults with large HPs or any SSPs or TSAs at index examination, individuals with index 5-9 mm HPs proximal to sigmoid are at increased risk for metachronous large SPs. Surveillance intervals should be considered appropriately.

Anderson, J., Robinson, C., Butterly, L. “Increased Risk of Metachronous, Large, Serrated Polyps in Individuals with 5-9 mm Proximal Hyperplastic Polyps: Data From The New Hampshire Colonoscopy Registry.” Gastrointestinal Endoscopy; Vol. 92, No. 2, 2020, pp. 387-393.

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