1. Chi-Yi Chen, Ming-Tse Hsu, Tsung-Jung Tsai, Yu-Min Feng, Ping-Hsin Hsieh, Chang-Chao Su, Li-Jen Chang, Chien-Chung Fang, Yu-Ling Lin, Tai-Tien Chung, Chu-Kuang Chou, Po-Yueh Chen GI section of Internal Medicine department, Chia-YiChristianHospital, Chia-Yi, Taiwan Introduction Painless endoscopy can achieve both good patient comfort and good doctor procedure performance. There was more patient desire to complete the upper GI panendoscopy(EGD) and low GI colonscopy(CFS) at one time with anesthesia. It is interesting to find the real-world results between EGD-CFS and Painless endoscopy can achieve both good patient comfort and good doctor procedure performance. There was more patient desire to complete the upper GI panendoscopy(EGD) and low GI colonscopy(CFS) at one time with anesthesia. It is interesting to find the real-world results between EGD-CFS andCFS-EGD. Aims Materials and Methods There were 5000 patients received both upper GI panendoscopy and lower GI colonscopy in 2013-2014. There were patients from OPD and healthy examination. The chief complaints of upper and lower GI problems were recorded. Both EGD and CFS were performed with anesthesia. EGD first then followed with CFS (EGD-CFS) or CFS-EGD were randomly decided by endoscopist and anesthesia There were 5000 patients received both upper GI panendoscopy and lower GI colonscopy in 2013-2014. There were patients from OPD and healthy examination. The chief complaints of upper and lower GI problems were recorded. Both EGD and CFS were performed with anesthesia. EGD first then followed with CFS (EGD-CFS) or CFS-EGD were randomly decided by endoscopist and anesthesiadoctor. Results The chief GI problems within the 5000 patients received both upper and lower endoscopy were 480(9.6%) upper GI symptoms, 1805(36.1%) lower GI discomforts, both upper and lower GI complaints in 1895 patients(37.9%). Health examination without GI complaints noted in 820 patients (16.4%).Peptic ulcers and colon polyps were the major findings of painless endoscopy. There were 3085(61.7%) EGD-CFS and 1915(38.3%) CFS-EGD. The recovery time and propofol dose were not significantly difference between EGD-CFS and CFS-EGD. No severe adverse event was found except two mild aspiration pneumonia and two fatal aspiration pneumonia complicated with ARDS immediately after examination. Unfortunately, all these four cases The chief GI problems within the 5000 patients received both upper and lower endoscopy were 480(9.6%) upper GI symptoms, 1805(36.1%) lower GI discomforts, both upper and lower GI complaints in 1895 patients(37.9%). Health examination without GI complaints noted in 820 patients (16.4%).Peptic ulcers and colon polyps were the major findings of painless endoscopy. There were 3085(61.7%) EGD-CFS and 1915(38.3%) CFS-EGD. The recovery time and propofol dose were not significantly difference between EGD-CFS and CFS-EGD. No severe adverse event was found except two mild aspiration pneumonia and two fatal aspiration pneumonia complicated with ARDS immediately after examination. Unfortunately, all these four cases occurred in CFS-EGD group. Conclusions It is safe and comfortable to receive both upper and lower GI endoscopy in anesthesia. EGD-CFS was safer than CFS- It is safe and comfortable to receive both upper and lower GI endoscopy in anesthesia. EGD-CFS was safer than CFS- EGD in real-world daily practice. To investigate the outcome of combined upper and lower endoscopy in anesthesia between To investigate the outcome of combined upper and lower endoscopy in anesthesia between EGD-CFS and CFS-EGD. Combined panendoscopy and colonscopy in Painless endscopy :EGD-CFS is safer than CFS-EGD