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Increased risk of metachronous large serrated polyps in individuals with 5- to 9-mm proximal hyperplastic polyps: data from the New Hampshire Colonoscopy Registry

  • Joseph C. Anderson
    Correspondence
    Reprint requests: Joseph C. Anderson, Department of Veterans Affairs Medical Center, 163 Veterans Dr, White River Junction, VT 05009.
    Affiliations
    Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA

    New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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  • Christina M. Robinson
    Affiliations
    New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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  • Author Footnotes
    ∗ Dr Butterly is the senior author and the Director of the NHCR.
    Lynn F. Butterly
    Footnotes
    ∗ Dr Butterly is the senior author and the Director of the NHCR.
    Affiliations
    Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA

    New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Dr Butterly is the senior author and the Director of the NHCR.
Published:April 26, 2020DOI:https://doi.org/10.1016/j.gie.2020.04.034

      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)
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