O SCVIR, 1998 PERCUTANEOUS gastrostomy and gastrojejunostomy are well established techniques that have excellent technical success rates and very few complications (1-5). One of the differences between percutaneous interventional radiologic techniques and surgical and percutaneous endoscopic techniques is the size of the catheter placed. Most percutaneous gastrostomy tubes are 12-14 F and percutaneous jejunostomy tubes range from 12 to 24 F, while endoscopically and surgically placed tubes are typically much larger (6). Smaller bore tubes may be more prone to clogging, as well as to mechanical problems such as kinking and breakage (5,7). Our experience with patient and referring physician complaints about smallbore gastrostomy and gastrojejunostomy tubes led us to consider placement of larger bore tubes. Several such tubes are available, most commonly consisting of Silastic balloon tip catheters ranging in diameter from 18 to 24 F. Smaller gastrojejunostomy tubes can be placed coaxially through these catheters and have adapters to fit them conveniently to the existing gastrostomy tube. One of the problems in initial placement of large-bore gastrostomy and gastrojejunostomy tubes is tract dilation. Even when gastropexy is used, the forces associated with serial dilation with rigid dilators mav cause detachment of the gastropexy and even inadvertent placement of the tube into the peritoneal cavity. Furthermore, with each dilator exchange there is a risk of spillage of gastric contents into the peritoneal cavity with subsequent peritonitis. We describe a technique for single-step tract dilation and peel-away sheath placement that circumvents these potential problems.