BACKGROUND AND AIMS: Colonoscopy is the gold standard for accurate exploration of the colon. Thus, it must be performed as efficiently as possible. The patient's tolerance considerably affects the quality of sedation free examinations. Pharmacological sedation can solve this issue; however, it can expose to significant adverse events. The aim of this study was to evaluate the impact of immersive virtual reality (VR) during sedation-free colonoscopy. METHODS: We conducted a prospective controlled study including outpatients presenting for unsedated colonoscopy. Patients were randomized into Group 1: colonoscopy with VR headset and Group 2: without intervention. Anxiety, comfort, and pain were respectively evaluated by State-Trait Anxiety inventory (STAI), Gloucester scale and the verbal rating scale (VRS). RESULTS: In total, 63 patients were included: intervention group G1 ( = 33) and control group G2 ( = 30). A slightly lower time to caecal intubation was noted in the intervention group without significant difference (G1 = 19 min vs. G2 = 26 min,  = 0.07). Patients with VR mask expressed lower levels of post-procedural anxiety than those in the control group (mean STAI G1 = 47 vs. G2 = 53,  < 0.01) and a significant decrease in the STAI score compared to pre-endoscopy values (8 vs. 4 points,  < 0.01). The per-procedural pain assessed by VRS was significantly lower in the patients using VR (Mean G1 = 0.44 vs. G2 = 1.32,  < 0.01). Moreover, endoscopic examination was found to be more comfortable with VR based on the Gloucester scale  < 0.01. CONCLUSIONS: Immersive VR technology is a promising, noninvasive and well-accepted tool for improving tolerance by reducing colonoscopy induced pain and anxiety allowing an optimized examination.