Endoscopic sedation has traditionally been considered to be an element of the endoscopic examination. Endoscopists, together with endoscopy nurses, administered benzodiazepines and opioids with acceptable safety and efficiency. Today, sedation practices for endoscopy have become more diversified due to the entry of anesthesia specialists into the endoscopy unit, gastroenterologist-directed propofol administration, and prolonged diagnostic and therapeutic procedures that require deeper sedation. The economic implications of these changes in sedation are examined in this article.