We recommend for colonoscopy that alternatives to sedation, including no sedation, inhalational agents and other adjuncts, are considered.（Evidence level: Moderate；Recommendation grade:Strong).

We suggest that lower GI endoscopy with deep sedation (propofol) or general anaesthesia should be available for selectedpatients undergoing planned prolonged procedures or complex endotherapy.（Evidence level: Low；Recommendation grade:Weak).

We recommend that clinicians fully discuss with patients at an increased risk from sedation for endoscopy (eg, due to age, frailty or comorbidity), the benefits and potential risks of sedation and alternatives to sedation, including no sedation.（Evidence level: Low；Recommendation grade:Strong).

We recommend that frail, elderly or comorbid patients (ASA grade 3 or greater) are given half or less of the dose required for younger healthy patients and need smaller incremental doses, if required.（Evidence level: Low；Recommendation grade: Strong).

We suggest that patients with established cardiovascular disease at high risk of cardiac dysrhythmias undergo ECG monitoring and have supplemental oxygen during endoscopy with sedation.（Evidence level: Low；Recommendation grade:Weak).

We recommend that patients at risk of myocardial ischaemia during endoscopy with sedation should continue their normal anti-anginal therapy and receive supplemental oxygen before, during and after endoscopy.（Evidence level: Low；Recommendation grade:Strong).

We recommend that patients with decompensated chronic liver disease undergoing endoscopy with sedation should be assessed for hepatic encephalopathy prior to endoscopy.（Evidence level: Low；Recommendation grade:Strong).

We recommend patients with hepatic encephalopathy or chronic liver disease with American Society of Anesthesiologists(ASA) grade 4 or more who are undergoing endoscopy should have this undertaken with anaesthetic support.（Evidence level: Low；Recommendation grade:Strong).

We recommend adjunctive non-invasive ventilation and high-flow oxygen in patients with chronic progressive neuromyopathic disorders and severely impaired respiratory function (forced vital capacity <50% predicted) undergoing endoscopy with conscious sedation.（Evidence level: Moderate；Recommendation grade:Strong).

We recommend that patients with renal impairment (estimated glomerular filtration rate <30 ml/min/1.73 m2) under_x005fgoing endoscopy with sedation should have their doses of opioids or benzodiazepines reduced.（Evidence level: Low；Recommendation grade:Strong).