Background: The demand for screening endoscopy has increased dramatically over the past 5 years. Most endoscopy in the US is performed under conscious sedation. With the aim of increasing efficiency in endoscopy units, two dichotomous trends have emerged: 1) propofol sedation; and 2) unsedated endoscopy. Aim: To determine national practice patterns of GI endoscopists' regarding unsedated endoscopy, propofol sedation and attitudes towards the role of unsedated endoscopy for screening purposes. Methods: A brief survey was developed, tested, and converted to a Web-based format. All members of the ASGE were invited via email to participate and surveys were collected electronically on the World Wide Web. Preliminary results are reported. Results: 348 national ASGE members responded to the survey, 93% were gastroenterologists (318 were men). 55% practice in the community and 45% practice in an academic center. 48% do not routinely offer unsedated EGD and colonoscopy, and only 15% of these respondents plan to incorporate unsedated endoscopy into their practice in the next year. Of those who perform unsedated endoscopy, 85% do no more than 25 unsedated procedures per year. Lack of patient acceptance was the most common reason cited for using sedation. Routine use of propofol sedation for EGD, colonoscopy and ERCP/EUS was reported by 17%, 19% and 17% respectively, and endoscopists were more likely to use propofol in the community than at academic centers (p<0.005, p<0.007, and p<0.03 respectively.) 43% of those not currently using propofol plan to incorporate it into their practice within the next year. The majority of endoscopists would themselves choose to be sedated for endoscopy (73% for EGD, 82% for colonoscopy). Most endoscopists felt that the availability of unsedated esophagoscopy or colonoscopy would not significantly increase screening for Barrett's esophagus or colonic polyps/colorectal cancer, respectively. Conclusions: Unsedated endoscopy has limited acceptance in the US, and its use is not likely to increase significantly. In contrast, propofol sedation has already gained acceptance in the community and the routine use of propofol in endoscopy units will likely increase in the future.