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An endoscopic evaluation, particularly ileocolic mucosal and histological findings, is essential for the diagnosis of inflammatory bowel disease (IBD). The introduction of antitumor necrosis factor agents has changed the therapeutic paradigm of patients with IBD, but an endoscopic evaluation is more important to guide therapeutic decision-making. In the future, endoscopy with a histological evaluation will be increasingly used in patients with IBD. Both Crohn colitis and ulcerative colitis result in an increased incidence of colorectal carcinoma. Thus, surveillance colonoscopy is important to detect early neoplastic lesions. Surveillance ileocolonoscopy has also changed recently from multiple random biopsies to pancolonic dye spraying with targeted biopsies of abnormal areas.

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