Ileocolonoscopy is a very useful diagnostic examination for the assessment of inflammatory bowel disease. Specific indications justify the procedure only when they are likely to influence therapeutic management. Colonoscopy of the entire colon and the terminal ileum can be necessary to establish a differential diagnosis, to determine the extent of inflammatory activity, preoperatively to guide the surgeon, and to examine the bowel proximal to stomas. Early endoscopic examination of the ileocolonic anastomosis after resection of the terminal ileum and part of the colon enables evaluation of the severity of recurrence, predicting clinical outcome. Routine postoperative colonoscopy is, however, not warranted, as we do not have a medical treatment influencing evolution of the disease. Total colonoscopy is also indicated for prevention of cancer in long-standing ulcerative colitis. The best screening strategy has still to be identified.