Lower gastro-intestinal endoscopy is a common investigative procedure which can be distressing. The extent of this distress is not known, nor have the predictive factors been identified. The aim of the present study was to identify to what extent it is distressing, what factors might predict distress in this population and to identify coping strategies that may mediate such distress. Service implications are also explored. Three hundred and one patients awaiting a lower gastro-intestinal endoscopy during a 9-month period from two separate hospitals were sampled using a cross-sectional survey design. Participants completed a battery of questionnaires comprising demographic and health information, the Hospital Anxiety Depression Scale, the Brief COPE, the Social Provisions Scale, the Life Orientation Test Revised and two Appraisal Scales. Patients were found to be significantly more anxious than the general population but not more depressed. Coping strategies of self-blame and self-distraction, threat appraisals of endoscopy procedure and control appraisals of results, low optimism, presence of symptoms, low social support, and gender were found to account for 56.3% variance in anxiety. Longer times on the waiting list increased the degree to which the procedure was appraised as a threat. High levels of distress are evident in this population. There is a clear need for better identification of distressed patients and the appropriate provision of psychological support.