A percutaneous gastrostomy introduction system may include may include an elongate tube assembly including one or both of a dilator portion and a gastrostomy tube portion, which may be continuously formed or joined by one or more connection joints that may—in certain embodiments—provide for rotation about a common longitudinal axis. The dilator portion includes a helical surface for advancing contact with body tissue and may be disposed near (including up to and defining) a first end of the elongate tube assembly. An engagement structure, including—for example—one or more of a wire loop, a user-graspable handle, or another graspable structure may be included at the first end of the device. Device embodiments may be effective to lessen or prevent tenting of patient tissue during introduction.