A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique. The entire procedure is performed under endoscopic visualization. Our experience with more than 100 successful tube placements has made this method common practice at our institute. This technique is ideal for patients with poor gastric emptying of any etiology. We feel that this technique will have an expanding and important role in the future management of this patient population's nutritional problems.