The balance between risks and benefits of gastrointestinal endoscopy for a given patient is essential in defining the appropriate use of endoscopic procedures. The current literature suggests that gastrointestinal endoscopy infrequently results in major procedure-related morbidity and mortality, while cardio-respiratory events occur commonly. However, true complication rates may be underestimated due to inconsistencies in the types of complications reported. No formal reporting requirements exist, and most of the published studies on complications come from centres with highly-skilled endoscopists.