Multiple endoscopic options exist for physicians seeking to provide palliative therapy for patients with colorectal cancer. Endoscopic decompression tubes can allow urgent stabilization for patients with malignant obstruction requiring some form of surgical palliation. Patients who are not candidates for palliative surgery can experience good symptomatic relief from malignant large bowel obstruction via laser therapy or placement of a colonic stent. Laser therapy can be used in conjunction with SEMS to recanalize and decompress large bowel in certain situations. The use of colonic stents is rapidly becoming more commonplace as acceptance of the technique becomes more widespread. Patients with unresectable disease may be able to avoid surgery altogether and achieve successful and lasting palliation of large bowel obstruction. Overall, they provide effective and durable palliation in patients with malignant obstruction, have an excellent risk/benefit profile, and are within the technical means of both gastroenterologists and interventional radiologists.