PURPOSE: This study compared efficacy and safety of a colostomy and stent placement as a palliative management in obstructive colorectal cancer. METHODS: The patients underwent either a colostomy (16 patients) or endoscopic stent placement (14 patients). Patients with metastatic cancer and those who rejected surgery due to their advanced age and poor systemic state were enrolled in this study. RESULTS: The mean age of patients in the colostomy group (CG) and in the stent group (SG) was 61 and 66, respectively. The mean APACHE II score in the CG and SG was 4.5 and 6.9, respectively (P=0.026). The time to the first meal after the procedure was 3.8+/-1.7 days and 1.9+/-0.8 days in the CG and the SG, respectively (P=0.002). The frequency of analgesic injections after the procedure in the CG and SG was 3.7+/-2.8 and 0.2+/-0.4, respectively (P= 0.001). The mean hospital stay in the CG and the SG was 15.8+/-13.9 days and 7.0+/-3.5 days, respectively (P=0.026). The mean healthcare cost in the CG and SG was 6,085,000+/-3,959,683 won and 4,041,000+/-2,487,857 won, respectively (P=0.212). CONCLUSION: No serious complications occurred in the endoscopic stent group. There was a statistically significant difference between the two groups in the time to the first meal, the pain control frequency, and hospital stay after the procedure. Therefore, endoscopic stent placement might be a preferable option for the palliative treatment of patients with obstructive colorectal cancer.