The article by Wernli et al1 in the April issue of Gastroenterology is important because it demonstrates an association between use of anesthesia services and increased 30-day colonoscopy complication rates, but is subject to several criticisms. First and foremost, is this increased complication rate directly owing to anesthesia use or does it artifactually increase from the confounding factor of sicker patients preferentially receiving anesthesia services? As a gastroenterologist, I generally request anesthesia services for sick patients undergoing colonoscopy, and generally forgo anesthesia for relatively healthy patients.