Complications are a part of the practice of medicine. This is amply true for gastrointestinal endoscopy. The medications currently used in the practice of gastrointestinal endoscopy are essential to our ability to perform the wide array of diagnostic and therapeutic procedures that have become the hallmark of modern day gastroenterology. As in all of medicine, a decision is based on an assessment of risk versus benefit. Yes, these medications do carry risk with their use; however, with proper preparation and careful administration, the benefits derived far exceed the risks. We are able to perform a host of endoscopic surgical procedures precluding higher risk alternatives; patients are saved the anxiety and discomfort associated with the procedure and, in situations where follow-up procedures are necessary, they usually are more than willing to return. Maintaining these gains is the responsibility of the gastrointestinal endoscopist community and requires the recognition of the risks and a continuous effort to minimize them.