Background: Colonoscopy procedure is an accepted modality for the evaluation of colonicrndiseases. It performed for both diagnostic and therapeutic indications. Centers performing rncolonoscopy in the developing world is being limited for reasons of lack of adequate manrnpower training, better equipment supply and improved knowledge of patients to seek care inrnaddition to a shift in the increasing trend of gastrointestinal malignancies. Reports on the practicerntrend of endoscopy in general and colonoscopy in particular, in Ethiopia are limited and most arernolder studies. rnObjective: The main objective of the study was to analyze colonoscopy indications andrnoutcomes at GI Unit, Tikur Anbessa Specialized University Hospital, Addis Ababa, Ethiopia. rnPatients and Methods: This was Institution based retrospective cross sectional studyrnconducted at Tikur Anbessa Specialized Hospital GI Unit on 659 patients undergone rncolonoscopy evaluation from September 2016 to August 2020. rnResults: The mean age of patients in the study was 45.5 years with SD Â±16.4. Majority of rnpatients were from Addis Ababa. Rectal bleeding (28.8%) was major indication for colonoscopy.rnMost of the colonoscopies done after excellent and good preparation (85%). Cecal intubation raternwas 85% and had statistically significant association with degree of bowel preparation. The mainrnreason for failed intubation of the cecum was mass (42.6%). Normal and mass were found inrn37.2% and 14.4 % of colonoscopies respectively. 86.4% of histologic diagnosis were colonicrnadenocarcinoma and most (77.8%) found in rectosigmiod and descending colon area. There werernsignificant number of reports of nonspecific inflammation. rnConclusions: The common indication for colonoscopy was rectal bleeding and majority ofrnadenocarcinomas were on the left side of the colon. Mass lesion was the common reason of rnfailed cecal intubation. There were significant number of reports of nonspecific inflammation.