A refined endoscopically controlled percutaneous tube gastrostomy has been described in detail, and the experience gained in 28 patients has been reported herein. A majority of the patients had severe underlying neurologic disorders, malignancy of the oral pharynx or esophagus or chronic intestinal obstruction due to advanced malignancy. The three groups of patients were analyzed regarding mortality and morbidity. Three minor complications occurred in the entire group, and three in-hospital deaths occurred which were unrelated to the tube. In addition, four other patients died from their underlying disease several months after discharge from the hospital. Analysis of this technique has shown it to be safe, easy to perform, and acceptable to the patients and supporting personnel. A cost analysis showed significant savings when this technique was utilized instead of operative gastrostomy.