We enthusiastically read the well-designed, population-based study by Bielawska et al1 that evaluated the important question of risks of anesthesia assistance (AA) in outpatient colonoscopy. In this secondary data analysis, the authors selected 2 cohort groups with close propensity scores and evaluated for risks of complications in AA as compared with unassisted procedures. There were no differences in perforation or spleen injury rates. However, the risk of aspiration pneumonia was 63% higher among patients who had AA.