Large bowel endoscopy, the most accurate diagnostic investigation of the colon and rectum has been available at the Korle-Bu Teaching for close to two decades and has been used mostly for diagnosis. This retrospective study assessed patients who have undergone large bowel endoscopy, with the aim of defining the utilization of the diagnostic yield and the predominance of the varied methods. From January 1998 to December 2011, a total of 2,151 patients comprising 1,302(60.5%) males and 763(35.5%) females underwent large bowel endoscopy. Patient age ranged from 8 to 100 years with a median age of 53 years and an inter-quartile range of 25 -72 years. The proportion of the varied methods was: colonoscopy (832; 39%), flexible sigmoidoscopy (704; 33%), rigid sigmoidoscopy (406; 19%) and proctoscopy (192; 9%). Bleeding per rectum (57.0%) was the commonest primary complaint with an overall diagnostic yield of 48.4%. In 888(41.6%) cases no pathology was found. Haemorrhoidal disease accounted for 690(32.3%) cases followed by tumours 191(9.0%). Sigmoidoscopy (both rigid and flexible) diagnosed 141(95.3%) of the tumours and colonoscopy diagnosed the remaining 7(4.7%) tumours Complete colonoscopy was achieved in 491(59%) cases scheduled for colonoscopy. In most symptomatic cases the diagnostic yield of endoscopy was high with tumours being the second commonest diagnosis after haemorrhoids. Many of the tumours were diagnosed with the sigmoidoscope. It is therefore recommended that flexible sigmoidoscopy be made available in all hospital in Ghana.