Percutaneous endoscopic gastrostomy (PEG), a safe and effective procedure, is an alternative to open gastrostomy. There are two techniques of placing PEG tubes. One technique consists of a pull-string Ponsky-Gauderer type gastrostomy and the other a push-over-wire Sachs-Vine type gastrostomy. After the gastrostomy tube is positioned, a repeat endoscopy is performed to determine optimal placement of the PEG tube. The purpose of this study was to determine the necessity of a repeat endoscopy to determine the optimal positioning of the PEG tube. Charts of 132 patients who underwent a PEG procedure between July 1, 1994 and September 30, 1996 were reviewed. Specifically, we assessed whether the endoscopist changed the position of the bumper during repeat endoscopy after PEG placement. PEG was performed successfully in 125 of 132 adult patients. Of 125 patients, the endoscope was reintroduced after PEG in 110 patients. A minor adjustment was defined as repositioning of the bumper by < or = 1.0 cm and a major adjustment as > 1.0 cm. The endoscopist made no adjustment in initial placement of the gastrostomy tube bumpers in 102 of 110 patients (93%). A minor adjustment was made in 5 patients (4%), and a major adjustment was made in 3 patients (3%). Therefore, in 102 of 110 patients (93%), initial placement of the gastrostomy tube bumpers was felt to be adequate, and repeat endoscopy was not necessary. Thus, repeat endoscopy is not routinely required to assess the proper positioning of the internal bumper. Repeat endoscopy should be at the discretion of the endoscopist if there is suspicion of improper positioning of the bumper along the gastric mucosa.