Aims <p>The aim of this study was to the effects of music during the endoscopy procedure on anxiety, pain and vital signs.</p> Methods <p>This study was conducted as a randomized, controlled, double-blind trial. The study population consisted of patients in the endoscopy unit of a university hospital between June and December 2023. The patients were randomly divided into the experimental group (<i>n</i> = 38), who listened to music during endoscopy, and the control group (<i>n</i> = 37), which did not receive any intervention other than routine nursing care. This study, data were collected via a patient information form, the State-Trait Anxiety Inventory (STAI-State), the visual analogue scale (VAS), and a vital signs monitoring form. A significance level of 0.05 was used to interpret the results.</p> Results <p>Within-group analysis revealed a statistically significant decrease in postprocedural anxiety (STAI) and pain (VAS) scores in both the music and control groups (all p values = 0.001). However, between-group analysis revealed no statistically significant difference between the music and control groups in terms of postprocedural anxiety (<i>p</i> = 0.645) and pain (<i>p</i> = 0.132). A statistically significant difference was found in oxygen saturations of patients in the experimental and control groups before endoscopy (<i>p</i> &lt; 0.05). No statistically significant differences were found between the groups in terms of heart rate, respiratory rate, oxygen saturation, blood pressure, or pain level after endoscopy and at the 5th minute of endoscopy (<i>p</i> &gt; 0.05).</p> Conclusions <p>Music during endoscopy was not found to have statistically significant differences between groups in terms of heart rate, respiratory rate, oxygen saturation, blood pressure, or pain level. It is also possible that the positive effect observed within groups was related to the completion of the procedure, excluding the music. It can lead to studies for more and larger working groups.</p> Trial registration <p>ClinicalTrials.gov, Registration number: NCT06756919. Registered on 24.12.2024.</p>