Introduction: The COVID-19 pandemic led to a significant increase in the number of ventilator-dependent patients requiring long-term enteral feeding with percutaneous gastrostomy tubes (G-tubes). Placement of G-tubes in these patients presents unique challenges as the procedure is aerosolizing and poses risk to staff via bodily fluid and fomite transmission. Overall, there has been minimal data on the rates, safety, and ideal methods of G-tube placement in COVID-19 patients. Our study aimed to determine the proportion of COVID-19 patients who required G-tube placements, procedural services utilized, rates of adverse events, and staff exposures in a large academic medical center. Methods: In this single-center retrospective cohort study, hospitalized patients admitted with positive COVID-19 PCR tests from 1/1/20 through 6/9/20 were reviewed. For patients who underwent G-tube placement, demographics, comorbidities, procedural details and associated adverse events were collected for 7 days post-procedurally and compared to the same period in 2019 as a control. Staff involved with the procedure were surveyed for any reported cases of COVID-19. Results: Of 710 COVID-19 positive patients, 36 (5.1%) underwent G-tube placement compared to 24 in 2019 (Table). G-tubes were placed for persistent dysphagia, tracheostomy-dependence, or inadequate oral nutrition. G-tubes were placed most often in the ICU at the bedside with sedation. Most placements were performed by Surgery (42%), followed by GI (22%) and IR (19%). No procedural staff subsequently tested positive for COVID-19. Adverse events occurred in 13.9% of placements (3 patients (8%) had an aspiration within 7 days, 1 had abdominal wall bleeding, and 1 had a wound infection). There were no occurrences of perforation, peritonitis, dislodgement, GI bleeding or death. Placement at bedside in the ICU was not associated with adverse events when compared to all other locations (5 total, P = 0.02). Conclusion: This study demonstrates that among COVID-19 patients admitted to a tertiary care center, there were high rates of G-tube placements with overall low complications for both patients and staff. The overall adverse event rate was 13.9%, within the range reported in the literature (10-16%). Given improved outcomes for patients, overall low complications, and no known staff COVID-19 infections after placement, bedside endoscopic placement of G-tubes for COVID patients in the ICU can be considered a safe first-line approach.Table 1.: Details of PEG Placement in 36 total COVID-19 patients.