Endoscopic advancements have revolutionized the diagnosis, monitoring, and management of inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Ileocolonoscopy remains the criterion standard for initial diagnosis, guiding therapeutic strategies and providing baseline disease characterization.

The available literature was systematically reviewed, including articles focusing on the role of endoscopy in IBD diagnosis, disease activity assessment (endoscopic scoring), postoperative monitoring, and therapeutic interventions assessing their impact on reducing surgical intervention and optimizing disease management.

Endoscopic scoring systems, including the Mayo Endoscopic Subscore, Ulcerative Colitis Endoscopic Index of Severity, and Simple Endoscopic Score for Crohn’s Disease, provide standardized evaluation of disease activity and treatment response. Knowledge of these scoring systems is essential in the modern era for managing IBD. Postoperative surgical anatomy can pose a different challenge, and an understanding of these is very important for a practicing gastroenterologist. In recent years, the role of endoscopy has evolved from diagnosis to therapeutic interventions such as endoscopic balloon dilation, stricturotomy, and stent placement to effectively manage adverse events like strictures and fistulas, minimizing the need for surgery. Advanced endoscopic techniques, including mucosal resection, submucosal dissection, and full-thickness resection, have transformed the management of dysplasia, reducing the risk of colectomy.

This review underscores the critical role of endoscopy in optimizing patient outcomes through accurate diagnosis, therapeutic precision, and integration of emerging technologies.