Guideline Video

Guideline Resources

  • Endoscopic Management of Benign and Malignant Colonic Strictures
  • American Society for Gastrointestinal Endoscopy
  • June 4, 2026
  • Summary
  • Full-text

Video Transcription

Just published June 4th, 2026, the American Society for Gastrointestinal Endoscopy’s newest guideline on Endoscopic Management of Benign and Malignant Colonic Strictures.

The goal of this guideline is to provide evidence-based recommendations, focusing on 5 specific sections: initial assessment including best practices for endoscopic assessment, biopsy, and tattooing, management of malignant colonic obstruction from potentially resectable colorectal cancer (CRC), management of malignant colonic obstruction from unresectable CRC, management of malignant colonic obstruction from extracolonic malignancy, and management of benign colonic strictures.

In today’s rapid update, we’ll just be going over the key recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Colonic Obstruction Caused by Potentially Resectable Colorectal Cancer

  • In patients with colonic obstruction from highly suspected or confirmed 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

Next the section on 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 

Moving on to the section on 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 

Next the section on 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

On to the section on 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

And last the section on 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 benign colonic strictures refractory to EBD when technical expertise is available

And there you have it. Make sure to check out the full guideline from the American Society for Gastrointestinal Endoscopy and other related clinical decision support tools at guidelinecentral.com.

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