Purpose <p>Percutaneous endoscopic gastrostomy (PEG) is commonly used for long-term enteral feeding in pediatric patients with inadequate oral intake. However, anatomical challenges, such as cranially displaced stomachs due to severe spinal deformities, can hinder standard PEG placement, particularly in children with neurological disorders like cerebral palsy. This study assesses the feasibility and safety of an intercostal approach for PEG placement in pediatric patients with a high-positioned stomach.</p> Methods and patients <p>Two 11-year-old girls with cerebral palsy and right-sided kyphoscoliosis underwent PEG placement through the seventh intercostal space due to their cranially displaced stomachs. A 15 Fr, 1.5 cm PEG tube was inserted using the endoscopic “pull” method, taking care to avoid intercostal nerves and vessels. Both patients began feeding 6 h after the procedure and were followed up for 1 and 2 years.</p> Results <p>PEG placement was successful without significant complications. Minor granulation tissue around the stoma was observed but did not affect tube function. The intercostal approach enabled early feeding and was well tolerated with no pain or discomfort.</p> Conclusion <p>The intercostal approach for PEG is a safe, viable alternative for pediatric patients with cranially displaced stomachs, allowing prompt feeding initiation. Larger studies are needed for further validation.</p>