The 20-year technology slump in endoscopic innovation is finally giving way to a flurry of technologies, of which many are directed specifically at improving or even replacing traditional colonoscopy. These technologies include “smart” overtubes, electronically mapped and driven instruments, and completely self-propelled devices. In addition to nonendoscopic technologies such as CT, these innovations may dramatically alter the practice of colorectal cancer screening, the “bread and butter” of gastroenterologists in this country. There are multiple and complex forces driving these changes, including a mismatch between the supply and demand in colonoscopy, patient convenience and comfort, costs, and more recently, a growing concern about the miss rate of conventional colonoscopy.