Background and Aims
Because 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) 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 SPs and advanced neoplasias (ANs) in patients with 5- to 9-mm
proximal HPs.
Methods
We included adults with at least 1 polyp resected at index colonoscopy and a surveillance
examination 12 months or more after index. Outcomes were risk for metachronous large
(≥1 cm) SPs and ANs (≥1 cm, villous elements, high-grade dysplasia, or colorectal
cancer [CRC]). Individuals were hierarchically stratified by the most significant
index SP. The risks for adults with proximal 5- to 9-mm HPs at index examination were
compared with individuals with index findings of large (≥1 cm) HPs or any SSPs or
TSAs, nonsignificant HPs (<1 cm in rectosigmoid or <5 mm anywhere in colon), high-risk
adenomas (AAs or ≥3 adenomas, no SPs), and low-risk adenomas (no SPs). We present
absolute and adjusted risks of metachronous polyps from a regression model that included
age, sex, body mass index, smoking, previous polyp history, family history of CRC,
year of diagnosis, endoscopist SP detection rates, and months to surveillance examination.
Results
A total of 8560 NHCR participants were included (44.8% women; average age, 59.0 years;
standard deviation, 9.1). Similar to those with large HPs or any SSPs/TSAs at index
examination (odds ratio, 7.63; 95% confidence interval, 4.78-12.20), individuals with
proximal 5- to 9-mm HPs had an elevated risk for metachronous large SPs (odds ratio,
4.77; 95% confidence interval, 2.54-8.94) as compared with adults with low-risk conventional
adenomas.
Conclusions
NHCR data suggest that similar to adults with large HPs or any SSPs or TSAs at index
examination, individuals with index 5- to 9-mm HPs proximal to the sigmoid are at
an increased risk for metachronous large SPs. These novel data suggest that close
surveillance intervals may be appropriate for patients with 5- to 9-mm proximal HPs.
Abbreviations:
AA (advanced adenoma), BMI (body mass index), CRC (colorectal cancer), CSSP (clinically significant serrated polyp), HP (hyperplastic polyp), NHCR (New Hampshire Colonoscopy Registry), SP (serrated polyp), SSP (sessile serrated polyp), TSA (traditional serrated adenoma), USMSTF (U.S. Multi-Society Task Force)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 26, 2020
Accepted:
April 8,
2020
Received:
November 8,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by American Society for Gastrointestinal Endoscopy 2018 Endoscopic Research Award (grant nos. R01CA131141, 1R21CA191651-01A1 to JCA), the National Cancer Institute (contract no. HHSN261201400595P to LB), the Norris Cotton Cancer Center (LB), and Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH (LB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
If you would like to chat with an author of this article, you may contact Dr Anderson at [email protected]
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© 2020 by the American Society for Gastrointestinal Endoscopy
