Purpose <p>This study explored the trends, demographic patterns, and regional disparities in gastrostomy procedures using Japanese nationwide receipt databases.</p> Methods <p>Age- and sex-stratified data on gastrostomy procedures from 2014 to 2022 were analyzed using Jonckheere-Terpstra tests and Poisson regression models. The number of inpatient gastrostomies, surgeons, physicians in gastroenterology, and neurologists (with and without board certification) were assessed by prefecture. Disparities across 47 prefectures and urban–rural disparities were quantified using Gini coefficients and unpaired <i>t</i>-tests. Correlations were assessed using Pearson’s correlation method.</p> Results <p>The average annual number of gastrostomies was 55,577 (rate: 44.0 per 100,000), with a slight male predominance (male-to-female ratio, 1:0.9). A minor peak occurred in the 0–4&#xa0;year-old age group (9.6 procedures), followed by a sharp increase after 40&#xa0;years old, peaking at ≥ 90&#xa0;years (374.8 procedures). The age-adjusted rates declined overall (risk ratio: 0.957–0.959, P &lt; 0.0001), particularly among the elderly. The Gini coefficient showed low inequality for gastrostomies. The number of gastrostomies was significantly higher in rural than in urban regions. Moderate correlations were found between the number of gastrostomies and the number of surgeons and physicians in gastroenterology without board certification.</p> Conclusion <p>This study highlights demographic and regional disparities in gastrostomy practices in Japan.</p>