Three hundred and sixteen patients underwent 330 percutaneous endoscopic gastrostomies (PEG) of the Russell or introducer type. Seventy-five percent of the patients had neurological conditions that precluded swallowing. Absolute contraindications included pharyngeal or esophageal obstruction, uncorrectable coagulopathy or inability to perform endoscopy. The mean age of the patients was 75 years. The procedure took an average of 17.5 min to perform. PEG could not be performed in 14 patients (4.1%). Major complications occurred in 2.1% of patients, including 5 who developed peritonitis. No infections occurred at the gastrostomy tube site. The procedure mortality was 0.6%. PEG never required general anesthesia. For patients with long-term swallowing abnormalities, PEG is preferred to nasogastric feeding, operative gastrostomy or parenteral alimentation.