Ileocolonoscopy is at present an essential tool for diagnosing inflammatory bowel disease, assessing disease for prognostic purposes, and guiding therapeutic interventions. Severe endoscopic lesions are associated with poor disease outcomes, since both in Crohn’s disease and ulcerative colitis, most severe endoscopic features are associated with increased risks of surgery. Patients with a higher degree of amelioration of endoscopic lesions after treatments share a low risk of disease progression. Classification of disease activity according to endoscopic scores might contribute to a more objective disease assessment, is essential for clinical trials, and allows subsequent evaluation and grading of disease activity variations. The most commonly used scoring systems are the Mayo endoscopic subscore and the UCEIS (ulcerative colitis endoscopic index of severity) for ulcerative colitis, the Rutgeerts score for postsurgical Crohn’s disease, and the CDEIS (Crohn’s disease index of severity) and SES-CD (simple endoscopic score for Crohn’s disease) for the assessment of ileocolonic Crohn’s disease. However, some limitations and caveats have to be considered when using endoscopic scores. Capsule endoscopy is a complementary technique to visualize small bowel lesions, with limited but extremely valuable indications in inflammatory bowel disease diagnosis and assessment. Upper GI endoscopy is less commonly used in the standard diagnostic workup of adult inflammatory bowel disease; however, it can complement other diagnostic techniques, at least in selected cases. Nursing is crucial to ensure adequate bowel cleansing, adherence of patients to pre- and post-procedure prescriptions, and to assist patients during endoscopic procedures. Although those undertaking these roles are not necessarily dedicated IBD nurses, they should have basic IBD knowledge to adequately support patients through these procedures. Moreover, a dedicated IBD-nurse service can support patients beyond the procedure, often seeing a patient in recovery or following endoscopy to focus on issues related to their disease or to arrange medical plans going forward. A concordant approach contributes to patients’ empowerment, especially as endoscopic procedures may be decision points for patient care.