Hartstein JD, et al. - Given that current postpolypectomy guidelines surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk, researchers ascertained if 6 to 9 mm adenomas detected at colonoscopy were correlated with greater risk of advanced neoplasia at follow-up vs baseline 1 to 5 mm adenomas. A colonoscopy database at a single US academic center was retrospectively assessed. Included were patients with baseline examinations showing tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas. Findings revealed that there were 2,477 qualifying baseline colonoscopies. In patients with 1 to 5 mm adenomas, the absolute risk of metachronous advanced neoplasia rose from 3.6% to 6.9% in patients with at least one 6 to 9 mm adenoma. Compared with patients with only diminutive (1-5 mm) adenomas, patients with baseline small (6-9 mm) adenomas have an elevated risk of advanced lesions on follow up. Guidelines for postpolypectomy should consider risk stratification based on small vs diminutive adenomas.