Since the early 1990s self-expanding metallic stents (SEMS) have been used as an alternative to emergency surgery in the treatment of malignant colorectal obstruction. The sparse literature on the subject was reviewed. SEMS seems to be an acceptable palliative procedure in disseminated patients, but as a “bridge to surgery” before elective resection the results from expert single centers and small randomized multicenter trials are conflicting. The most worrying issue is a possible negative effect on long-term survival after SEMS because of a risk of disseminating tumor cells by the procedure.