The objective of this study was to evaluate the use of percutaneous decompression gastrostomy in patients with gynecologic malignancies. Decompression gastrostomy tubes were inserted percutaneously in patients with recurrent gynecologic malignancies and small bowel obstruction or fistulae. The technique was evaluated for successful gastric decompression, acute and long-term complications, and palliation of symptoms. Twenty patients underwent placement of percutaneous gastrostomy tubes for decompression. Tube placement was successful in all patients, and all had significant relief of symptoms. There were no acute complications. Seven patients required replacement of tubes due to accidental dislodgment, balloon malfunction, obstruction or leakage around the tube, or systemic disease. Tubes remained in place for 7 to 184 days (mean 53). Sixty percent of patients returned home for palliative care for 3 to 173 days (mean 70). It was concluded that percutaneous decompression gastrostomy can be successfully performed in patients with recurrent gynecologic malignancies, and offers significant relief of symptoms and improvement in quality of life.