The many variations of surgical gastrostomy for nutritional support or for long-term gastric decompression all have a significant morbidity and mortality. An 'incisionless' technique under local anaesthesia, namely percutaneous endoscopic gastrostomy, was described in 1980. A review of the literature shows that the percutaneous technique is safer for the patient, easier and faster to perform and considerably cheaper than surgical gastrostomy. As the few complications usually require surgical management, percutaneous endoscopic gastrostomy should be considered a surgical technique. Few patients are unsuitable for the percutaneous endoscopic technique and this route should be considered for all patients referred for a gastrostomy.