The presence of small and diminutive proximal hyperplastic polyps is associated with higher rates of synchronous advanced neoplasia compared with patients without serrated lesions

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). 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,