A method for creating a tract for percutaneous endoscopic guided gastrointestinal tube creation including the steps of providing a puncture wire having a sharp tissue penetrating tip shielded in a sheath, the puncture wire slidable within the sheath and releasably lockingly engaged thereto； inserting the puncture wire and sheath in a first direction through a working channel of an endoscope to exit the channel of the endoscope, then releasing the puncture wire from the sheath and advancing the puncture wire from the sheath while visualizing via the endoscope the position of the puncture wire, and further advancing the puncture wire through the visceral wall and then the abdominal wall of a patient. Subsequent methods to position a percutaneous gastrointestinal catheter after initial wire puncture are described.
