American Society for Gastrointestinal Endoscopy guideline on endoscopic management of benign and malignant colonic strictures (Gasrointestinal Endoscopy)

The ASGE has released an updated guideline covering the endoscopic evaluation and management of benign and malignant colonic strictures. For potentially resectable colorectal cancer causing obstruction, the guideline conditionally favors colonic SEMS placement as a bridge to surgery over emergency surgery, citing higher rates of primary anastomosis, fewer permanent stomas and fewer postoperative adverse events. For unresectable CRC, palliative stenting is favored over surgery, while balloon dilation remains the first-line approach for benign strictures. The guideline also outlines a growing role for stricturotomy and lumen-apposing metal stents in selected benign strictures that are refractory to conventional therapy. Importantly, the recommendations acknowledge the limitations of the evidence, including concerns around cancer recurrence with bridge-to-surgery stenting and stent migration in benign disease.