The tube pharyngostomy has been all but forgotten in recent years, and rightfully so when a PEG or PEJ is possible. Nevertheless, the tube pharyngostomy should remain in the armamentarium of the GI surgeon for selected patients in whom longer term enteral access is not available by PEG or PEJ for various technical reasons, for those who absolutely refuse a nasoenteric tube, or as terminal palliation in patients with nonoperable but obstructing intra-abdominal neoplasms. Not only is it easy to place (albeit requiring a brief general anesthetic), but these tubes are much more comfortable than the “misery” to the patient of a nasoenteric tube by avoiding the annoying nasal and nasopharyngeal irritation,sinusitis, trouble with speech and coughing, and general discomfort of a longer term, indwelling nasoenteric tube. Moreover, the tube can be hidden under a turtleneck-types weater, thereby avoiding the social discomfort of a tube exiting the nares. The overall lack of experience and ignorance, not only with these tubes but also with their concept, has precluded many surgeons from recognizing their usefulness,albeit in highly selected patients. With these advantages and caveats in mind, the tube pharyngostomy can prove a valuable adjunct in selected patients.