Colonic polyps are common lesions of the lower digestive tract and often represent precursors of colorectal adenocarcinomas. Their accurate detection and characterization are essential for appropriate management and for optimizing screening and prevention strategies.

Endoscopic classification systems such as the Paris, NICE (Narrow-band Imaging International Colorectal Endoscopic), and CONNECT (Classification for Optical Diagnosis of Colorectal Neoplasia) classifications were developed to standardize the description of polyps and predict their histological nature.

This study aims to assess the accuracy of these classifications in characterizing colonic polyps and to evaluate their correlations with histopathological results in order to determine their reliability and clinical relevance.

This is a retrospective descriptive study conducted between 2018 and 2025 within our department. All adult patients (aged over 18 years) who underwent complete ileocolonoscopy with polypectomy and for whom the Paris, NICE, and CONNECT classifications were used to describe the polyps were included. Histopathological data corresponding to each resected polyp were collected.

A total of 134 polypectomies were recorded, including 129 polyps classified according to the Paris classification, 4 according to the CONNECT classification, and 1 according to the NICE classification. The mean age of patients was 61.7 years [26–85], with a clear male predominance (sex ratio 1.9).

Polyps were discovered during endoscopy performed because of rectal bleeding (40%) or a history of polypectomy (19%). The remaining polyps were incidentally found during colonoscopy performed for chronic abdominal pain (9.5%), chronic constipation (8%), follow-up of inflammatory bowel disease (7.5%), chronic diarrhea (6.5%), investigation of anemia (4.5%), personal history of surgically treated familial adenomatous polyposis (2%), family history of FAP (1%), family history of colorectal cancer (1%), and radiation proctitis (1%). Most resected polyps were located in the colon (83%), predominantly in the left colon (68%), and 17% were found in the ileocecal region.

Regarding the Paris classification, 95% of polyps were classified as 0-Is and 5% as 0-Ip. This classification is based solely on macroscopic features and does not directly predict the histological nature of the lesions. Histopathological analysis revealed that 56% were tubular adenomas with low-grade dysplasia, 17% sessile serrated adenomas with low-grade dysplasia, 10% tubulovillous adenomas with low-grade dysplasia, 9% inflammatory pseudopolyps, 5% hyperplastic polyps, 1% glandulocystic polyps, 1% intramucosal adenocarcinoma arising in a tubular adenoma with high-grade dysplasia, and 1% fibroblastic polyps (Vanek’s tumor). For the CONNECT classification, four polyps were identified: Two CONNECT IIA polyps corresponded to Paris 0-Is polyps: one was a tubular adenoma with low-grade dysplasia and the other an inflammatory pseudopolyp on histology. One CONNECT IIA polyp corresponded to a Paris 0-Ip polyp, histologically confirmed as a tubular adenoma with low-grade dysplasia. One CONNECT IH polyp corresponded to a Paris 0-Ip polyp, confirmed as an inflammatory pseudopolyp. For the NICE classification, a single polyp was identified: A NICE 1 polyp corresponded to a Paris 0-Is polyp, confirmed histologically as a hyperplastic polyp.

This study shows that the Paris classification, being solely macroscopic, is the most frequently used system in our setting for describing colonic polyps. However, it does not allow prediction of the histological nature of lesions, unlike the NICE and CONNECT classifications, which show generally good correlation with histology. Nevertheless, the limited use of the NICE and CONNECT classifications in our study restricts the interpretation of these findings. More systematic use of these scoring systems could improve diagnostic accuracy and the effectiveness of screening strategies.