Purpose <p>To compare the safety and efficacy of balloon-assisted gastrostomy (BAG) placement to the conventional serial dilation technique.</p> Methods <p>This study is an IRB-approved retrospective review of all percutaneous gastrostomy tubes placed by an interventional radiology department at a single institution between 2012 and 2021. There were 476 patients identified (average age 63, 44% female): 385 in the serial dilation group and 91 in the balloon assisted gastrostomy (BAG) group. Patient demographic, procedure, and radiological data were reviewed in the medical record to determine procedure success, procedure/fluoroscopy time, and tube failures. Gastrostomy tube failure was defined as tube leak, clogging, or dislodgement. Adverse events were classified as per Society of Interventional Radiology guidelines. Statistical analysis was performed using Fisher’s exact test, student’s t-test, and Mann-Whitney U-test as appropriate.</p> Results <p> Gastrostomy tubes were successfully placed in 97.7% (377/385) of patients undergoing the serial dilation technique and 100% (91/91) of patients undergoing the BAG placement technique. BAG tube placement was associated with a 2.5&#xa0;min decrease (47%) in average fluoroscopy time ( <i>p</i>  = 0.0002, CI: 3.76 to 1.20). Total procedure time was reduced by an average of 17.2&#xa0;min (22%) ( <i>p</i>  = 0.0006, CI: 26.9 to 7.4). BAG was also associated with an 11% reduction in all cause gastrostomy tube failure ( <i>p</i>  = 0.0399). There were no statistically significant differences in the adverse event rates or median days to tube failure. Material costs were $178.32 higher in the BAG group.</p> Conclusion <p>BAG catheter placement can be performed safely and effectively, and is associated with reduced fluoroscopy time, procedure time, and overall failure rate compared to the serial dilation technique.</p> Graphical abstract <p></p>