Anderson JC, et al. - Using the New Hampshire Colonoscopy Registry, the authors evaluated the risk of clinically important metachronous lesions associated with serrated polyps (SPs), detected during index colonoscopies. They found index large SP or index sessile and traditional serrated adenoma (STSA) with no index high-risk adenomas (HRA) increased the risk of metachronous large SPs but not metachronous HRA in an analysis of data from a population-based colonoscopy registry. At index colonoscopy, HRA and synchronous SPs significantly increased the risk of metachronous HRA. Therefore, individuals with HRA and synchronous could benefit from close surveillance.