Are small adenomas on initial colonoscopy really a risk factor for advanced neoplasia on surveillance colonoscopy?

We read with interest the article by Sneh Arbib et al1 regarding the risk of advanced lesions at follow-up colonoscopy after polypectomy of diminutive (1-5 mm) versus small (6-9 mm) polyps. The authors conclude that polyp size 6 to 9 mm, >2 polyps, and fair bowel preparation on index colonoscopy are associated with advanced neoplasia on follow-up. However, several issues with this study should be addressed.

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