In Reply Solutions are needed to decrease the costly increase of discretionary monitored anesthesia care use in low-risk patients undergoing screening colonoscopy. A study of US Veterans suggested that unsedated colonoscopy using water exchange was acceptable to those without escort resources and those with a personal preference for no sedation. Unsedated colonoscopy reduces indirect recovery costs for screening and surveillance colonoscopy and allows patients to return to work the same day. These studies also suggest that patients’ knowledge of the unsedated option is critical to its acceptance.