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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) hyperplastic polyps (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 serrated polyps (SPs) and advanced ade