A retrospective study was undertaken to compare the complications of surgical feeding gastrostomy in 100 consecutive patients with those of percutaneous nonendoscopic gastrostomy in 133 consecutive patients. The age and sex distribution and indications for gastrostomy were similar in both groups. Thirty-day mortality in the surgical group was 12% and in the percutaneous group 7.5%. Complications requiring surgical treatment occurred in 8% and 1.5% of the surgical and percutaneous patients, respectively. Significant nonsurgical complications, such as bleeding, aspiration, and myocardial infarction, occurred in 11% of patients undergoing surgical gastroscopy and 3.0% of those with percutaneous gastrostomy. Minor complications, such as mild wound infection and pericatheter leakage, occurred in 14% of surgical patients and in 0.7% of percutaneous patients. Overall, there were significantly fewer complications with percutaneous gastrostomy than with surgical gastrostomy (p less than 0.01). We conclude that percutaneous, nonendoscopic gastrostomy is safer than surgical gastrostomy and hence the preferred method for long-term enteral feeding.