Background <p>Fluoroscopically guided jejunal tube placement via percutaneous endoscopic gastrostomy (PEG-J) provides minimally invasive post-pyloric access in children. Limited data exist regarding routine application and procedural risks.</p> Objective <p>To evaluate the safety and technical success of PEG-J in pediatric patients, performed without general anesthesia or sedation.</p> Materials and methods <p>All pediatric cases of fluoroscopically guided PEG-J procedures performed between 2011 and 2025 were included. Fluoroscopic images were reviewed to determine the final position of the tube tip. Technical success, complications, anatomical variants, and tube patency were assessed. Fluoroscopy time and dose area product (DAP) were documented.</p> Results <p>A total of 126 PEG-J procedures in 60 children (36 males) were analyzed. The technical success rate was 85% (107/126) with final tube tip placement in the jejunum in 88 cases (82%) and in the duodenum in 19 cases (18%). Nineteen procedures (15%) were unsuccessful, including six with documented anatomical causes (steep vertical duodenal entry, <i>n</i>=2; malrotation, hiatus hernia, hooked stomach in superior mesenteric artery syndrome, steep take-off of the jejunum with kinking of the tube at the ligament of Treitz, <i>n</i>=1 each) and 13 without documented reasons. The median fluoroscopy time was 5&#xa0;min 24&#xa0;s (range, 2&#xa0;s–37&#xa0;min), at a frame rate of 0.5 frames per second. The median DAP was 6.1&#xa0;cGy·cm² (range, 0.08–343&#xa0;cGy·cm²).</p> Conclusion <p>Fluoroscopically guided PEG-J placement is a safe and effective procedure in pediatric patients, with high technical success and low radiation exposure.</p> Graphical Abstract <p></p>