From September 1980 to April 1986, 185 percutaneous endoscopic gastrostomies were performed at University Hospitals of Cleveland. Of these, nine (5%) were done for chronic gastrointestinal decompression and form the basis of this report. Patients ranged in age from 21-73 years (mean: 51 years) and all had prolonged, complex hospitalizations extending 25-122 days (mean: 63 days). The only complication associated with the procedure was the identification of transhepatic placement of the catheter, which caused no adverse effects. Two of the nine patients died during hospitalization of causes unrelated to the gastrostomy construction. The goals of gastric decompression and elimination of nasogastric intubation were achieved in all patients. In one patient with gastric intestinal disconnection, the percutaneous gastrostomy was effective as the sole means for elimination of swallowed saliva and gastric output. Three patients continued to use the gastrostomies for chronic decompression after discharge for the remainder of their lives (2 months, 6 months, and 2 years, respectively). Percutaneous endoscopic gastrostomy may provide a safe, secure, and comfortable method of long-term gastric decompression in a select group of high-risk patients with complex intra-abdominal processes.