We read with interest the recent study by Wernli et al1 describing a large retrospective analysis of >3 million patients to asses the relative risks of anesthesia services during colonoscopy. The authors correctly highlight the importance of this issue; anesthesia services are now employed in nearly 50% of cases. Although the results of the study provide us greater insights into the gastrointestinal (GI) practices across the country, we are concerned that the methodologic limitations of the study may lead some to misinterpret the findings.