Lower gastrointestinal bleeding (LGIB), defined as bleeding originating distal to the ligament of Treitz, is a common reason for consultation in gastroenterology, often related to colorectal lesions. Colorectal polyps, implicated in 6–12% of LGIB cases, include adenomatous polyps with malignant potential and non-adenomatous polyps. According to the literature, 25–40% of adenomatous polyps progress to colorectal adenocarcinoma within approximately ten years, highlighting the importance of screening and early management.The aim of our study was to determine the prevalence of colorectal polyps in the context of LGIB, to describe the epidemiological and clinical characteristics of affected patients, and to analyze the endoscopic and histological features of these lesions along with their therapeutic management.

This was a retrospective, descriptive study conducted over a 3-year period, from January 1, 2022 to October 31, 2025, within our department. The study included all patients who underwent colonoscopy for evaluation of LGIB with endoscopic confirmation of colorectal polyps. Data were collected from colonoscopy report registries. Descriptive analysis was performed using a standardized data collection sheet ensuring patient anonymity.

During the study period, 160 colonoscopies were performed for LGIB, identifying 54 cases of colorectal polyps, yielding a prevalence of 33.7%.The male-to-female ratio was 1.6 (33 men, 21 women). The mean age was 51.7 years (range: 23–78), with 72% of patients aged ≥45 years (39 patients). One patient (2%) had a family history of familial adenomatous polyposis (FAP), and 20 patients (37%) were chronic smokers.

Clinically, 34 patients (63%) presented with isolated rectorrhagia, while 20 (37%) had associated symptoms, including anemia (9 cases), constipation (4), proctalgia (3), weight loss (2), diarrhea (1), and abdominal pain (1).

Endoscopically, polyps were mainly located in the left and right colon (n=20; 37%), followed by the rectum (n=6; 11.1%). Extensive colonic involvement was observed in 2 patients (3.7%).Thirty patients (55.6%) had sessile polyps and 14 (25.9%) had pedunculated polyps. Eight patients (14.8%) had both sessile and pedunculated polyps, 2 (3.7%) had pedunculated and flat polyps, and 1 patient (1.9%) had sessile and flat polyps.A single polyp was found in 28 patients (51.9%), and 2 cases (3.7%) of colorectal polyposis were reported.

Regarding size, 33 patients (61.1%) had polyps measuring 3–10 mm, 9 (16.7%) had polyps 1–2 mm, and variable sizes were observed in 8 patients (14.8%).

Most patients underwent polypectomy (n=53; 98%), including cold-snare resection in 12 patients (22.2%) and mucosectomy in 2 patients (3.7%).Seventeen patients (31.5%) had associated endoscopic findings, such as a tumoral process (6 cases), internal hemorrhoids (4), uncomplicated diverticulosis (3), angiodysplasia (2), mild proctitis (1), and colonic melanosis (1).

Histopathological analysis identified 45 adenomatous polyps (83.3%), including 28 (51.9%) tubular, 11 (20.4%) serrated, and 6 (11.1%) tubulovillous. One hyperplastic polyp (1.9%) and 3 cases (5.6%) of in situ adenocarcinoma were also noted.

Colorectal polyps are a frequent cause of lower gastrointestinal bleeding, accounting for 37.8% of cases in our study, and carry a significant risk of malignant transformation. Our findings underscore the importance of systematic screening and early management to prevent progression to adenocarcinoma.