Objective To explore the clinical value of small intestinal decompression tube combined with colon metal stent in the treatment of malignant colonic obstruction. Methods A retrospective cohort study was conducted to collect patients with malignant colonic obstruction treated by endoscopy in Department of Digestion, Hangzhou First People"s Hospital Affiliated to Medical College of Zhejiang University from June 2010 to September 2018. The patients were divided into two groups according to endoscopic treatment methods. The combined group consisted of small intestinal decompression tube and colon metal stent, and the simple colon metal stent was the simple group. Success rate and complication rate of operation, anastomosis mode and complication rate of follow-up surgery, length of stay and cost of treatment. Results A total of 83 patients were enrolled, including 18 in the combined group and 65 in the simple group. There was no significant difference in the general situation between the two groups (P > 0.05). There was no significant difference in the success rate of colon metal stent implantation between the combined group and the simple group (100% (18/18) vs 98.5% (64/65) P > 0.05). The complications of the two groups included infection, bleeding, perforation and stent implantation. There was no significant difference in shedding (5.6% (1/18) compared with 21.9% (14/64) P > 0.05); the time from metal stent implantation to surgery in the combined group was significantly shorter than that in the simple group (9.58 + 5.76 days) (P = 0.032), and the postoperative infection complications in the combined group (12.5%) were significantly lower than that in the simple group (54.2%) (P = 0.040). There were no significant differences in anastomosis, length of stay, hospitalization expenses, bleeding, perforation and death between the two groups (P > 0.05). Conclusion Endoscopic metal stent placement or combined with small intestinal decompression tube is safe and effective in the treatment of malignant intestinal obstruction, and the use of small intestinal decompression tube before metal stent placement can significantly reduce the infection rate after surgery, which is worthy of promotion.