We describe our six-year experience in establishing a colonoscopy service in a pediatric surgical center in Hong Kong. A total of 65 colonoscopies on 60 children (aged 1 to 16 years) were performed, with the pediatric surgeon being the collaborator in the first 27 examinations and the endoscopist in the subsequent 38 examinations. Except on two occasions when bowel preparation was inadequate, all examinations were successful. General anesthesia was employed initially but with more experience, sedation alone (37 cases) was found to be adequate in most children and even in infants. Barium enema was available in 20 cases and had a low diagnostic accuracy in comparison to colonoscopy, being incorrect in six cases and inconclusive in one case. Therapeutic procedures with colonoscopy included removal of arteriovenous malformation (1) and polypectomy (37); 24 polyps were situated beyond the reach of rigid sigmoidoscopes and two patients had previous failed polyp removal by laparotomy in another hospital. There were no complications in our series. Our experience suggests that pediatric colonoscopy is a useful procedure that can be safely and effectively performed by pediatric surgeons after adequate training.