The presence of small and diminutive proximal hyperplastic polyps is associated with higher rates of synchronous advanced neoplasia compared with patients without serrated lesions.Thayer H, Karen M, Marcus E, Waqas H, Brett M, Shriram J, Joshua M. Gastrointest Endosc. 2018 Jan 11. [Epub ahead of print]

BACKGROUND:The association of proximal small and diminutive hyperplastic polyps (HPs) with synchronous neoplasia (AN) is not well defined. However, sessile serrated polyps, even when small, are known to portend synchronous neoplastic risk.

Currently, when proximal small hyperplastic polyps are detected, the USMTF does not recommend a change in surveillance interval. We aimed to compare the rates of synchronous AN in a screening colonoscopy cohort of patients with small and then diminutive proximal HPs in comparison, first to a cohort absent any serrated or proximal hyperplastic polyps, and then in comparison with a cohort with small proximal sessile serrated polyps (SSPs).METHODS:Consecutive screening colonoscopies were recorded between 2005 and 2010 at an academic medical center. Patients were divided into three mutually exclusive groups. Group 1 consisted of patients with at least one HP that is proximal to the sigmoid colon, <1 cm in endoscopic size, and up to 3 total HPs in number. Group 2 included patients without any proximal HPs or SSPs. Group 3 consisted of patients with 1 to 2 SSPs, with at least one being proximal to the sigmoid colon, that were <1 cm in endoscopic size, and without dysplasia. Rates of synchronous AN in patients with small (<1 cm) and diminutive (<5mm) proximal HPs were compared with the other two groups.RESULTS:There were 482/2569 (18.8%) patients with a small proximal HP who met criteria for Group 1. The rate of synchronous AN in patients with a small proximal HP (61/482, 12.7%) was significantly greater compared with the average risk non-serrated cohort (Group 2; 133/1878, 7.1%, p<0.001). There was no significant difference in rate of synchronous AN when the small proximal HP group was subdivided by size (<5 mm, 51/404, 12.6% vs 6-9 mm, 10/78, 12.8%; p=1.00). The rate of synchronous AN in patients with diminutive (<5mm) proximal HPs (51/404, 12.6%) was not significantly different than the rate observed with proximal SSPs of similar size (17/113, 15.0%; p= 0.529).CONCLUSIONS:Patients with small and diminutive proximal HPs tend to harbor higher rates of synchronous AN compared with those without any serrated lesions detected on screening colonoscopy. Surveillance outcomes for metachronous advanced neoplasia for patients with small proximal HPs deserves further study. The synchronous AN rate in patients with proximal diminutive HP is similar to that of proximal diminutive SSP, and could have implications in a resect and discard strategy.

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