Objective: The usefulness of skin level gastrostomy tubes (button systems) for maintaining nutrition support after primary insertion of percutaneous endoscopic gastrostomy (PEG) is widely accepted. Technical and usability problems have forced the development of new systems. The experience with a newly developed skin-level gastrostomy system (Freka-Button Gastrostomy) in oncological patients is described. Methods: In a cohort study we prospectively evaluated for ease of use, complications, and time to failure, a modified balloon button system based on the MIC-Key type. It differs from other systems by its application mode and balloon design. Since February 1998, 18 systems were applied in 15 patients (median age 56 years, 42 to 72 years, 14 men, 1 woman). Results: Correct application of the 18 buttons in 15 individuals was easy and fast to perform (median intervention time 10.8 minutes). During follow-up (median 201, range 2 to 590 days) 1 button was removed because of the patient's decision, 2 others had to be renewed because of technical problems, and no major complication occurred. Conclusions: The new Freka-button system provides an easy-to-use, safe, and feasible alternative for long-term use of skin-level gastrostomy tubes in oncological patients.