Upper endoscopy may be used to replace percutaneously placed endoscopic gastrostomy (PEG) tubes which are not removable by traction. Several techniques have been developed to prevent slipping of the internal cross bar during retraction through the esophagus but the problem still exists as well as a risk of related complications such as mucosal laceration or airway obstruction. We propose a simple single-step method for PEG gastrostomy tube replacement which guarantees complete security of the removable portion of the tube. It also eliminates mucosal trauma, facilitates passage of the internal bumper through the diaphragmatic pinch and upper esophageal sphincter due to a strictly axial position of the removable fragment of the tube behind the leading endoscope. The technique will be summarized as follows: the first step consists of cutting a lateral hole on the gastrostomy tube 1 cm above the skin; then, a snare is passed into the tube from the stomach; the snare is opened and sent through the previously opened lateral orifice; the gastrostomy tube is passed through the open snare and secured by closing the snare tightly. The tube is then cut above the snared region and pulled into the stomach followed by the tip of the replacement gastrostomy tube. The bumper and internal fragment of the `old' gastrostomy tube can be positioned in a way that allows the endoscopist to view and ensure the proper placement of the new gastrostomy tube. Once the replacement tube is secured, the snare with the internal bumper is brought in contact with the tip of the endoscope. Then the endoscope is withdrawn with the snare secured at the entrance of the biopsy channel by winding it around the left thumb. To date, seven patients with ages ranging from 7 months to 3 years utilizing PEG gastrostomy tube from 3 months to 12 months have undergone this type of procedure without complications.