Endoscopy allows inspection and biopsy of mucosal surfaces of the gastro-intestinal tract in addition to some therapeutic manoeuvres that would otherwise require a more invasive approach. Childhood endoscopy is most commonly indicated when the diagnoses of inflammatory bowel disease, coeliac disease or reflux oesophagitis are under consideration. By considering the symptoms of these more common childhood indications for endoscopy as potential indications for endoscopy, the non-specialist is likely to be referring many of the less common conditions requiring endoscopy for the procedure. Diagnostic upper gastroenterology and biopsy in skilled hands is a very safe procedure. Diagnostic colonoscopy carries a 1/1000 risk of perforation and therapeutic endoscopy is associated with the greatest risks of complication. The risks and benefits of endoscopy are considered in the setting of the clinical indication.