Purpose <p>Percutaneous transesophageal gastro-tubing (PTEG) is an interventional radiology technique used for enteral feeding, or drainage in malignant bowel syndrome cases, serving as an alternative to percutaneous gastrostomy. Despite its safety and effectiveness in improving quality of life, comprehensive studies on PTEG tube replacement are limited. This study aimed to investigate the cases of PTEG tube replacement.</p> Material and methods <p>This single-center retrospective cohort study was conducted at the National Cancer Center Hospital, Tokyo, Japan. Data were collected from patients who underwent PTEG for malignant bowel obstruction or enteral feeding and then required tube replacement between January 1, 2014 and December 31, 2023. Patient characteristics, duration of tube indwelling, PTEG tube tip position, causes of replacement, and whether dilation or re-PTEG was performed during replacement were analyzed, excluding patients who were transferred or deceased before the initial replacement. Statistical analyses were performed using the Chi-square, Fisher's exact, and Mann–Whitney U tests, with significance set at P &lt; 0.05.</p> Results <p>Of 236 patients who underwent PTEG, 56 required an initial tube replacement. The mean age was 55 years, with 51.8 % of patients predominantly male. The primary indication for PTEG was decompression (52 patients). The median tube indwelling duration was 31 days, with the tube tip positioned in the gastric or duodenal in 64.3 % of cases. The most frequent reason for common replacement procedures, performed in 44 patients, was tube dysfunction. Replacement due to accidental removal in 12 patients led to higher rates of dilation or re-PTEG. The duration after accidental removal significantly affected the necessity for dilation or re-PTEG.</p> Conclusion <p>This study on initial PTEG tube replacement in cancer patients indicated that tube dysfunction is the primary reason for replacement, and accidental removal is more likely to require dilation or re-PTEG.</p>