ASGE 2026: Colonic Stenting Moves Ahead of Emergency Surgery in Selected Malignant Obstruction: GIE | August 2026 | Clinical Guideline

Introduction:

Management of colonic strictures increasingly includes advanced endoscopic options that may avoid emergency surgery or repeated dilation. The new ASGE guideline provides practical recommendations for both malignant obstruction and benign colonic strictures.

Why was this guideline needed?

Emergency surgery for malignant obstruction carries substantial morbidity.

Colonic stenting can provide rapid decompression and permit planned surgery.

Refractory benign strictures remain challenging.

Newer techniques such as LAMS and endoscopic stricturotomy require clearer positioning.

Key Takeaways:

Uncovered self-expanding metal stents (SEMS) are recommended for selected malignant colonic obstruction.

SEMS can be used as a bridge to elective oncologic surgery or for palliation.

This allows selected patients to move from emergency surgery toward endoscopic decompression followed by planned surgery.

Particular caution is required with colonic stenting in patients receiving bevacizumab.

For benign strictures, endoscopic balloon dilation remains first-line therapy.

Short benign strictures refractory to dilation may be considered for LAMS or endoscopic stricturotomy at experienced centres.

Patient selection, anatomy, oncologic intent, and local endoscopic expertise remain critical.

Several recommendations are supported by low or very-low certainty evidence.

What’s New?

ASGE provides a clearer endoscopy-first pathway for selected malignant obstruction and an escalation strategy beyond balloon dilation for refractory benign strictures.

Bottom Line:

For selected malignant colonic obstruction, SEMS can replace reflex emergency surgery with decompression followed by planned surgery. Advanced endoscopic options are also expanding for refractory benign strictures.