Open primary balloon gastrostomy (PBG) presents an potentialalternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic (GA), however the complication profile of PBGcompared to PEG is not well defined.Previous series comparing the two have been hampered by the two groups not being equivalent.Our paediatric surgical centre has offeredPBG as an alternative PEG since 2014. We used a matched case-control study to compare outcomes forPBG and PEG. MethodsPatients undergoing PBG were used as "cases"and matched 1:3 by age and diagnosis to patients undergoing PEG, demographics and clinical data as "controls". Primary outcome was rate of complications classified according to Clavien-Dindo(I-V). Secondary outcomes included time to feed and length of stay. Non-parametric, categorical analyses and multivariate logistic regression were performed. Data here presented as median [IQR]. ResultsWe included 140 patients (35 PBG:105 PEG). The two groups were comparable for gender, weight at surgery and follow-up duration. Median operative time was longer for PBG (43min ], p<0.001). Multivariate analysis demonstrated a statistically significant, higher incidence of symptomatic granulation tissue was more common in PBG (10(29%) vs 6(6%), p=0.0008), this remained significant on multivariate analysis ], p=0.001), nil other complication remained significant nor was overall complication rate statistically different. ConclusionsPBG and PEG have similar overall complication rates, however PBG appears to have a higher incidence of granulation tissue. This observation must be weighed against the need for further GA which is not insignificant in medically complex children.