Enteral nutrition is the modality of choice for both short- and long-term alimentation in patients with a functioning gastrointestinal tract. In patients unable to take oral feedings, long-term nutrition is best provided through a gastrostomy or jejunostomy tube. 1 Ho C Yeung EY Percutaneous gastrostomy and transgastric jejunostomy. AJR Am J Roentgenol. 1992; 158: 251-257 Crossref PubMed Scopus (85) Google Scholar , 2 Ponsky JL Gauderer MWL Stellato TA Aszodi A Percutaneous approaches to enteral alimentation. Am J Surg. 1985; 149: 102-105 Abstract Full Text PDF PubMed Scopus (161) Google Scholar Gastrostomy tube feeding is suitable for the majority of patients. However, in patients prone to pulmonary aspiration of gastric contents or with duodenal or gastric outlet obstruction, jejunal feeding is appropriate. A jejunostomy tube can be placed either by a direct operative procedure or by the percutaneous approach. 3 Shike M Wallach C Likier H Direct percutaneous endoscopic jejunostomies. Gastrointest Endosc. 1991; 37: 62-65 Abstract Full Text PDF PubMed Scopus (67) Google Scholar , 4 Ponsky JL Aszodi A Percutaneous endoscopic jejunostomy. Am J Gastroenterol. 1984; 79: 113-116 PubMed Google Scholar , 5 Salky B Kreel I Gelernt I Bauer J Nonoperative conversion of tube gastrostomy to feeding jejunostomy. Am J Surg. 1982; 143: 387-388 Abstract Full Text PDF PubMed Scopus (10) Google Scholar , 6 Wadiwala IM Bacon BR A simplified technique for constructing a feeding jejunostomy from an existing gastrostomy. Gastrointest Endosc. 1986; 32: 288-290 Abstract Full Text PDF PubMed Scopus (10) Google Scholar , 7 Lewis BS Mauer K Bush A The rapid placement of jejunal feeding tubes: the Seldinger technique applied to gut. Gastrointest Endosc. 1990; 36: 139-141 Abstract Full Text PDF PubMed Scopus (36) Google Scholar , 8 MacFayden Jr, BV Catalano MF Raijman I Ghobrial R Percutaneous endoscopic gastrostomy with jejunal extension: a new technique. Am J Gastroenterol. 1992; 87: 725-728 PubMed Google Scholar Although operative jejunostomy allows accurate placement of the feeding tube, the procedure is invasive, costly, and at times not feasible in patients who are poor surgical candidates. Various methods of percutaneous endoscopic gastrojejunostomy have been described. 3 Shike M Wallach C Likier H Direct percutaneous endoscopic jejunostomies. Gastrointest Endosc. 1991; 37: 62-65 Abstract Full Text PDF PubMed Scopus (67) Google Scholar , 4 Ponsky JL Aszodi A Percutaneous endoscopic jejunostomy. Am J Gastroenterol. 1984; 79: 113-116 PubMed Google Scholar , 5 Salky B Kreel I Gelernt I Bauer J Nonoperative conversion of tube gastrostomy to feeding jejunostomy. Am J Surg. 1982; 143: 387-388 Abstract Full Text PDF PubMed Scopus (10) Google Scholar , 6 Wadiwala IM Bacon BR A simplified technique for constructing a feeding jejunostomy from an existing gastrostomy. Gastrointest Endosc. 1986; 32: 288-290 Abstract Full Text PDF PubMed Scopus (10) Google Scholar , 7 Lewis BS Mauer K Bush A The rapid placement of jejunal feeding tubes: the Seldinger technique applied to gut. Gastrointest Endosc. 1990; 36: 139-141 Abstract Full Text PDF PubMed Scopus (36) Google Scholar , 8 MacFayden Jr, BV Catalano MF Raijman I Ghobrial R Percutaneous endoscopic gastrostomy with jejunal extension: a new technique. Am J Gastroenterol. 1992; 87: 725-728 PubMed Google Scholar Many are associated with problems, including retrograde migration of the tube, small-diameter tube, tube occlusion, and failure to protect from pulmonary aspiration. 9 Kaplan DS Murthy UK Linscheer WG Percutaneous endoscopic jejunostomy: long-term follow-up of 23 patients. Gastrointest Endosc. 1989; 35: 403-406 Abstract Full Text PDF PubMed Scopus (64) Google Scholar , 10 DiSario JA Foutch PG Sanowski RA Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc. 1990; 36: 257-260 Abstract Full Text PDF PubMed Scopus (189) Google Scholar , 11 Lewis BS Perform PEJ, not PED. Gastrointest Endosc. 1990; 36: 311-313 Abstract Full Text PDF PubMed Scopus (55) Google Scholar , 12 Henderson JM Strodel WE Gilinsky NH Limitations of percutaneous endoscopic jejunostomy. JPEN J Parenter Enteral Nutr. 1993; 17: 546-550 Crossref PubMed Scopus (46) Google Scholar Most of these problems are related to the technical difficulty in accurate jejunal placement of the feeding tube, which remains the “Achilles heel” of percutaneous endoscopic gastrojejunostomy (PEGJ).