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Purpose: To compare the effectiveness of percutaneous radiologic gastrostomy (PRG) by using cone beam CT and percutaneous endoscopic gastrostomy (PEG). Materials and Methods: This study retrospectively reviewed 129 patients who underwent PRG (n = 53) and PEG (n = 76) over a 2-years period. The C-arm cone beam CT images were obtained from all PRG patients before the procedure in order to decide the safest accessing routes. The parameters including technical success rates, complication rates and tube migration rates were all analyzed according to statistical methods. Results: The success rate of tube placement was higher in PRG than in PEG (100% to 93%, p = 0.08). Minor complications occurred in 5 patients o f the PRG grᄋ니p (10%; 5/53, 3 wᄋ니nd infection, 2 blood oozing), and occurred in 6 patients of PEG group (7.9%; 6/76, 5 wound infection, 1 esophageal ulcer). Major complications occurred only in 5 patients of PEG group (6.6%; 5/76, 1 panperitonitis, 4 buried bumper syndrome). There were no statistical differences of minor and major complication rates in the two groups (respectively, p = 0.759, p = 0.078). Tube migration rate was lower in PRG than PEG group (7.5% vs. 38.2%, p < 0.005). Conclusion: PRG using cone beam CT is the effective and safe method, the cone beam CT provides the safest accessing route during gastrostomy. Less tube migration occurs in the PRG than in PEG. [ABSTRACT FROM AUTHOR]