Gastrointestinal (GI) problems are common in patients with systemic sclerosis (SSc) and some develop pronounced underweight despite dietary intervention. Two patients with SSc were referred to our department because of severe GI symptoms and critical underweight. They had lost 24 and 23 kg, respectively, and their body mass index (BMI) was only 15 and 17 kg/m(2), respectively. After careful GI evaluation, both were treated with percutaneous endoscopic gastrostomy (PEG). Eight months later one patient had gained 13 kg (BMI 19 kg/m(2)) and after 5 months follow-up the other had gained 9 kg (BMI 20 kg/m(2)). Weight was no longer critically low and quality of life improved in both. In conclusion, PEG is an option in selected patients with severe malnutrition due to SSc. However, we advocate that thorough GI evaluation is performed in advance.