Patient comfort plays a role in acceptance of the procedure both initially and in surveillance. Unsedated colonoscopy should be offered to appropriate motivated patients and the use of some of the techniques discussed above (CO2 insufflation, water-aided colonoscopy, and smaller diameter scopes) may improve patient comfort during these exams. Likewise these techniques could allow for a decrease in the amount of sedation required for the exam and thus allow for fewer cardiopulmonary complications. Additional benefits beyond patient comfort may also impact the adaptation of these adjuncts. (C) 2017 Published by Elsevier Inc.