Clinical, Endoscopic, and Pathologic Spectrum of Pediatric Polyps: A Single-Center Study in the Current Polypectomy Era

<b>Background:</b> Pediatric gastrointestinal polyps represent a heterogeneous entity with variable clinical behavior, ranging from solitary benign lesions to syndromic forms associated with significant malignant potential. This study provides contemporary data, including upper GI and small-bowel polyps, with an unusually high syndromic yield (27.6%) compared to prior pediatric cohorts. <b>Methods:</b> This retrospective single-center study included children aged 0-18 years who underwent esophagogastroduodenoscopy and/or colonoscopy and were diagnosed with at least one gastrointestinal polyp between January 2015 and October 2025. Demographic characteristics, presenting symptoms, endoscopic features, histopathology, management strategies, and status of polyposis syndrome were collected. Statistical analyses were performed using IBM SPSS Statistics 27.0, with a significance threshold of <i>p</i> < 0.05. <b>Results:</b> Seventy-six patients (mean age 10.6 ± 5.0 years; 47.4% female) were evaluated. Gastrointestinal bleeding was the most common presenting symptom (37.1%). Solitary (63.2%) and sessile (59.2%) polyps predominated, with a median size of 7.0 mm (IQR 3.2-20.0). Juvenile (28.9%) and inflammatory (22.4%) polyps were the most frequent histologic subtypes. Polyposis syndromes were identified in 27.6% of patients and were significantly associated with multiple polyps (<i>p</i> < 0.001), proximal or intestinal distribution (<i>p</i> < 0.001), and adenomatous or hamartomatous histology (<i>p</i> < 0.001). Endoscopic polypectomy was successful in 94.7% of cases, with no major complications reported. <b>Conclusions:</b> Given the 27.6% prevalence of polyposis syndromes observed in this cohort, pediatric gastrointestinal polyps cannot be assumed to be uniformly benign. Our findings support comprehensive endoscopic evaluation, routine histopathology, and early genetic referral, specifically in patients with multiple, proximal, or mixed-morphology polyps.