Background/aims <p>Human schistosomiasis is a significant and, regrettably, overlooked tropical illness. This study was to examine the frequency and features of colonic schistosomiasis in patients exhibiting colonic symptoms at the endoscopy units of Mansoura University and the National Liver Institute (Menoufia University), Egypt.</p> Patients and methods <p>This study included 130 patients who were referred for colonoscopy due to various symptoms. They underwent comprehensive history taking, abdominal ultrasonography, and ileocolonoscopy with biopsies for a crush biopsy test after providing a written informed consent.</p> Results <p>Sixteen (12.3%) patients were confirmed to have schistosomiasis. Bleeding per rectum, followed by chronic abdominal pain, were the predominant complaints of Schistosoma infection among the cases. Ultrasound findings showed that 25% of positive cases had organomegaly (18.8% hepatosplenomegaly and 6.3% splenomegaly). Mucosal erythema and inflammation (n = 10, 62.5%) were the most often observed morphologic features during colonoscopy in positive patients. Polyps (n = 6, 37.5%) and mucosal ulcerations (n = 6, 37.5%) were the next most common findings, either alone or in combination.</p> Conclusion <p>Colonic schistosomiasis remains endemic in the Egyptian Nile Delta, with a frequency of 12.3% among the study’s patient population. The crush biopsy test is a simple and reliable technique for detecting both recent and chronic colonic schistosomiasis infections and could be employed to screen patients undergoing colonoscopy. </p> Clinical trial number <p>Not applicable.</p>