We thank the authors for their letter in response to our article, and welcome the opportunity to address their concerns. In their letter, Razjouyan et al suggest that there may be benefits to anesthesia assistance (AA) for colonoscopy not discussed in our study: specifically, the potential for higher cecal intubation rates (CIR) and better patient satisfaction. Based on these presumed benefits, the authors seem to be advocating for wide uptake of AA for colonoscopy, despite the indisputable higher cost1 and the small but important risks—even to the point of suggesting that higher risk patients be subject to endotracheal intubation to protect the airway. Although we agree that deep sedation (which necessitates the presence of an anesthetist) should be offered to select patients (eg, those with a history of painful colonoscopy or history of abuse, for whom colonoscopy may be traumatic), these patients are in the minority—in the large majority of cases, moderate sedation for colonoscopy is sufficient.