BACKGROUND: Self-expanding metal stents are frequently used to palliate patients with malignant dysphagia and close tracheoesophageal fistulae. Despite proper stent positioning and deployment, in a subset of patients there is no improvement in dysphagia, closure of tracheoesophageal fistulae, or resolution of anorexia. Such patients may require a PEG tube. It has been suggested that PEG placement through a preexisting esophageal stent is problematic because of the risks of gastrostomy tube impaction within the stent and resultant stent migration. METHODS: Case records were retrospectively reviewed of 9 consecutive patients with indwelling esophageal self-expanding metal stents undergoing attempted PEG. OBSERVATIONS: PEG tube placement was successful in all patients. In 1 patient, the stent migrated distally into the stomach during PEG placement. This was managed endoscopically without further complication. CONCLUSIONS: PEG placement in patients with previously placed esophageal self-expanding metal stents is a relatively safe and feasible procedure, although stent migration may occur.