Colonoscopy is nowadays one of the most important tools in diagnostic and therapeutic colorectal pathologies in adults and children. There is a lack of publications evaluating the indication of biopsies in pediatric patients. The colonoscopic multiple biopsies in macroscopically normal areas, increases the costs, the duration of the procedure and enhances morbidity. So, the clarification of the real necessity of biopsies is imperative. to investigate the agreement between the macro and microscopical findings in a retrospective study of the pediatric colonoscopies conducted between February 2007 and November 2010 in a single center. retrospective analysis of pediatric colonoscopies (0-18 years of age), performed by the same examiner, with attention to age, indication of the procedure, macro and microscopical findings. Patients with inadequate bowel prep were excluded from the study. The study was approved by the local Ethics Committee and an assigned consent form was obtained from each parent. Statistic analysis was performed using kappa indice and p value, beyond the sensitivity and specificity analysis. in that period 63 exams were performed. 12 were considered with inadequate bowel prep and excluded from the study. 51 patients were included in the study, with ages ranging from 5 to 200 months (mean 119,14). In 28 cases (54.9%) the exam was indicated by suspicious or for control of IBD, in 10 (19.6 %) for digestive hemorrhage, in 8 (15.6%) for investigation and control of polyposes, 1 for control after colectomy for FAP, 1 for suspicious of colon anastomosis stenosis and 3 in investigation for severe chronic bowel constipation. From a total of 51 exams, polyps were found in 16, when polipectomy was performed, reason for opting against performing multiple biopsies. These patients were excluded from the statistic analysis. The other 35 cases had been submitted to biopsies. From these, macrocospic findings were considered normal in 15 (42.8%) and in 20 some grade of alteration was recorded. In microscopic analysis, from the 15 normal exams, 10 showed alteration (eosinophilic colitis), and in the 20 with macroscopic alteration, only 1 was normal. If we consider biopsies as a gold standard for the diagnosis of bowel alterations, the sensitivity of the colonoscopy without biopsy was 65,52% and specificity was 33,3% (kappa index 0,3063, p<0,01), what demonstrates a low concordance between macro and microscopic findings. Our study showed great discordance between macroscopic and microscopic findings. We believe that colonoscopy is an invasive procedure and therefore its results should be maximized with biopsies, avoiding misdiagnosis. in pediatric population, colonoscopic routine biopsies should be considered, even in macroscopically normal areas. A multicenter study is necessary to reassure these results.