Purpose: Colonoscopy is widely available and a relatively safe procedure. We evaluated the findings of colonoscopy and the trends in our community setting. Methods: We retrospectively reviewed the charts of patients who underwent outpatient colonoscopy at two community outpatient centers during December 2002 to June 2003. Patients with previous history of colorectal cancer, history of colon surgery or recent pelvic radiation were excluded from the study. Information was obtained on demographics, colorectal cancer risk factors, indications and findings of colonoscopy. Results: A total of 177 profiles were used for the final analysis. The median age of our study group was 65 years. There were more women (60%) than men (40%). The majority of patients were whites (43%) followed by blacks (37%). The most common indication for colonoscopy was blood in stools (25%). About 10% patients underwent colonoscopy as a part of their routine screening for colorectal cancer. Around one quarter of patients had multiple indications for undergoing the colonoscopy. 41% patients had normal colonoscopic examination where as rest of them had either polyps or diverticuli or both. Majority of polyps (57%) were located on left side. When analyzed for all ages, left sided polyps showed a statistically significant association with a history of smoking (OR = 2.7. 95%CI = 0.97–4.3, p = 0.04). However, this association was even more significant in smokers above 50 years of age (OR = 3.17, 95%CI = 1.3-7.8, p = 0.005). We did not find any association between age and location of polyp. Logistic regression analysis matching all the risk factors still showed that cigarette smoking has an independent risk association with left sided polyps in people above the age of 50 years (OR = 2.18, 95%CI = 1.01-4.74, p = 0.04). In our study the commonest polyps were adenomatous (38%) and hyperplastic (21%). Seven percent were malignant. Conclusions: Colonoscopy has gained more attention recently as a cost-effective tool for colorectal cancer screening. However, it is also done for other indications. In our study it was done more often for other indications like heme positive stools/bleeding per rectum. A statistically significant association was found between polyp location and smoking in individuals above 50 years of age. However, this association needs further evaluation. Future studies with better quantification of smoking history are required to evaluate this association.