Today we are outlining the key recommendations from the American Society for Gastrointestinal Endoscopy (ASGE) guideline on Endoscopic Management of Benign and Malignant Colonic Strictures. Endoscopy plays a critical role in both the treatment of benign colonic strictures and the management of malignant colonic obstruction. This guideline provides evidence-based recommendations on initial assessment and management of both malignant colonic obstructions and benign colonic strictures. 

In today’s spotlight, we will go over key elements from the guideline. Refer to the full-text version for the complete and most thorough explanation of these recommendations.

Key Elements from the 2026 Guideline

Colonic Obstruction Caused by Potentially Resectable Colorectal Cancer

  • In patients with colonic obstruction from highly suspected or confirmed colorectal cancer (CRC) that appears surgically resectable, the American Society for Gastrointestinal Endoscopy (ASGE) suggests endoscopic placement of a colonic stent, when feasible, as a bridge to surgery over emergency surgery without stent placement

Colonic Obstruction Caused by Unresectable CRC

  • In patients with colonic obstruction from highly suspected or confirmed CRC that is deemed not curable by a surgical resection, the ASGE suggests endoscopic placement of a palliative colonic stent over palliative surgery. In patients currently receiving or who may receive bevacizumab, the ASGE suggests shared decision-making with surgeons, oncologists, and patients, when deciding between a colonic stent or palliative surgery 

Malignant Colonic Obstruction from Extracolonic Malignancy

  • In patients with colonic obstruction from extracolonic malignancy, the ASGE suggests guiding the decision between stent placement or surgery based on the specific tumor biology and multidisciplinary discussion. Stent placement is feasible in this setting; however, it has a higher risk of clinical and technical failure than intraluminal malignancy, and this should be openly discussed with patients for shared decision-making 

Selection of Self-Expandable Metal Stent Type for Malignant Colonic Obstruction

  • In patients with colonic obstruction from CRC undergoing endoscopic placement of a colonic stent,the ASGE suggests using uncovered self-expandable metal stents (SEMSs) over covered SEMSs

Endoscopic Metallic Stents Versus Endoscopic Balloon Dilation

  • In patients with symptomatic benign noninflammatory colonic stricture, the ASGE suggests the use of endoscopic balloon dilation (EBD) over endoscopic stent placement as a first-line therapy
  • Endoscopic stent placement with fully covered metal stents may be considered for benign colonic strictures that failed EBD after multidisciplinary evaluation. 
  • In patients with anastomotic colonic strictures of <15-mm length that are refractory to EBD, the ASGE suggests the use of lumen-apposing metal stents

Endoscopic Stricturotomy Versus Endoscopic Balloon Dilation

  • In patients with symptomatic benign noninflammatory colonic strictures, the ASGE suggests using EBD over endoscopic stricturotomy (ES) as first-line therapy. ES can be considered for short(<3 cm) benign colonic strictures refractory to EBD when technical expertise is available

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