In the modern world of endoscopic practice, it is not uncommon to encounter patients who have undergone creation of an ileal pouch with anal anastomosis (aka, a J-pouch) secondary to prior surgery to treat inflammatory bowel disease. Although on the surface, the endoscopic evaluation of the pouch itself sounds simple, in reality it is a somewhat complex endeavor, and there is a great deal to see, think about, and analyze during a so-called pouchoscopy. There are different types of pouch, different patterns of injury and inflammation in pouches, and various postsurgical adverse events to be on the lookout for, among other factors.