Abstract: Objective: To evaluate the feasibility and clinical value of endoscopic decompression with metal stents on acute malignant colorectal obstruction.Method: Twenty cases with acute malignant colorectal obstruction were treated with metal stents with the aid of endoscopy and X-ray. There were 11 cases with sigmoid colon, 4 cases with descending colon and 5 cases with rectal cancer. 15 cases were resectable with surgical indication and 5 cases were intraperitoneal widespread metastasis.Result: In 19 of 20 patients, metal stents were successfully inserted, obstructive symptoms were relieved within 1~2 days. 15 cases underwent surgical resection after 7~10 days, without complications, such as intraperitoneal infection and anastomotic leakage. Four cases were performed permanent metal stents for palliative treatment. One case was failed in recurrent obstruction after 51 days, and died from heart failure after operation. One case with widespread metastasis died from MODS. Recurrent obstruction was present in one patient with distal stent dislocation within 42 days, and a second stent was replaced with symptom remission.Conclusion: Metal stent insertion with the aid of endoscopy and X-ray is a safe, economic and effective method for malignant colorectal obstruction, and can reduce trauma and agony prominantly, and increase the living quality of patients.