We studied the use of a preoperative upper gastrointestinal series in children with and without major congenital anomalies undergoing gastrostomy tube (G-tube) placement. Of 1163 children evaluated, 743 had major anomalies and a total of 39 episodes of malrotation were found. All of the children with malrotation had either major congenital anomalies or cystic fibrosis. Our study suggests that an upper gastrointestinal series may be unnecessary before G-tube placement in children without other congenital anomalies or cystic fibrosis.