Image-guided placement of a feeding tube directly into the stomach — for patients who can't safely swallow enough for their nutritional needs long-term.
A percutaneous gastrostomy is a feeding tube placed directly through the skin of the abdomen into the stomach, allowing liquid nutrition, fluids, and medication to be given without needing to swallow. It's used when someone can't safely or adequately take enough by mouth for a period expected to last more than a few weeks — for shorter-term needs, a nasogastric tube passed through the nose is generally used instead, but for longer-term nutritional support, a gastrostomy tube is more comfortable, more discreet, and better tolerated over time.
The two main techniques for placing a gastrostomy tube are percutaneous endoscopic gastrostomy (PEG), placed with an endoscope passed down through the mouth, and percutaneous radiological gastrostomy (PRG) — sometimes called a radiologically inserted gastrostomy (RIG) — placed entirely using ultrasound and X-ray guidance, without any endoscope. Both achieve the same end result — a functioning feeding tube in the stomach — but the technique used depends on the patient's anatomy, the reason a tube is needed, and any factors that might make one approach safer than the other for that particular patient.
One of the most common reasons, when swallowing is significantly affected and isn't expected to recover quickly.
Motor neurone disease, advanced Parkinson's disease, or other progressive conditions affecting swallowing.
The tumour affects swallowing, or nutrition support is needed through radiotherapy.
Or critical illness where nutrition can't be reliably delivered by mouth.
Ultrasound and X-ray confirm the stomach's position, avoiding nearby organs.
Anchoring sutures secure the stomach wall against the abdominal wall.
The feeding tube is advanced into position over a guidewire.
Feeding can typically begin within several hours to the following day.
Stroke — one of the most common reasons for a feeding tube, when swallowing (dysphagia) is significantly affected and isn't expected to recover quickly enough to meet nutritional needs by mouth.
Neurological conditions such as motor neurone disease, advanced Parkinson's disease, or other conditions progressively affecting the ability to swallow safely.
Head and neck or oesophageal cancer, either because the tumour itself is blocking or affecting swallowing, or to support nutrition through a course of radiotherapy or chemoradiotherapy that's expected to make swallowing difficult for a period.
Prolonged reduced conscious level or critical illness where nutrition can't be reliably or safely delivered by mouth.
Other causes of severe, prolonged difficulty eating enough, assessed individually alongside the patient's treating team and, typically, a speech and language therapist or dietitian.
PEG remains the most widely used and generally preferred technique where it's straightforward to perform, since it's quick and allows a larger-calibre tube to be placed directly under endoscopic vision. However, PEG isn't always suitable or safe for every patient — situations where an endoscope can't easily be passed, where sedation for endoscopy carries higher risk, where there's a significant hiatus hernia, obstruction, or previous surgery altering the anatomy, or where a tumour in the mouth, throat, or oesophagus prevents the endoscope from reaching the stomach safely, are all situations where percutaneous radiological gastrostomy offers a valuable and, in some cases, the only realistic route.
Because PRG doesn't rely on passing an endoscope through the mouth and swallowing passage, it can often be performed even in patients where PEG isn't technically possible — including many patients with head and neck cancer, oesophageal obstruction, or altered anatomy from prior surgery — which is one of the main reasons radiological gastrostomy has become an increasingly used option, particularly in this specific group of patients. Comparative studies of the two techniques have generally found broadly comparable safety and success rates, with each approach having situations where it performs better than the other, which is why the choice is made individually based on what suits a given patient's anatomy and clinical situation.
Preparation: patients are usually asked to fast beforehand, and a nasogastric tube may be placed the day before or on the day of the procedure to distend the stomach with air, making it easier and safer to access accurately.
Imaging and access: under local anaesthesia, with sedation if needed, ultrasound and X-ray guidance are used to confirm the stomach's position relative to the abdominal wall and other organs, avoiding structures such as the colon or liver along the needle path.
Securing the stomach wall (gastropexy): in many techniques, small anchoring sutures are placed first to gently secure the stomach wall against the inside of the abdominal wall, keeping the two in close contact and reducing the risk of leakage around the new tube.
Tube placement: a needle puncture is made into the stomach under imaging guidance, and the feeding tube is advanced into position over a guidewire, with a final X-ray or contrast check confirming correct placement before the tube is put to use.
Recovery: most patients are observed for a period afterward, and feeding through the tube can typically begin within several hours to the following day, per local protocol.
The procedure typically takes around 30 to 45 minutes, and most patients go home the same day or after a short stay, depending on their overall clinical condition.
Caring for a gastrostomy tube day to day is generally straightforward and can be taught to the patient, family, or caregivers before discharge: keeping the skin around the tube clean and dry, checking regularly that the tube is sitting correctly and hasn't become displaced, and flushing the tube with water before and after feeds or medication to keep it from blocking. Most tubes need periodic routine exchange over time, which is a simple procedure, and the treating team will explain the specific schedule and any warning signs — such as leakage, redness, pain, or the tube falling out — that should prompt them to seek advice promptly.
Not necessarily — for many patients, particularly after a stroke or during a defined course of cancer treatment, a gastrostomy tube is a temporary measure that supports nutrition through a period when swallowing is unsafe or insufficient, and can be removed once oral intake recovers to a safe and adequate level. For other patients, particularly with progressive neurological conditions, the tube may be needed on a longer-term or permanent basis. This is discussed individually and reviewed over time by the treating team, alongside speech and language therapy input where swallowing may recover.
Percutaneous gastrostomy, whether placed endoscopically or radiologically, is generally a safe, well-established procedure. Recognised risks include infection or irritation at the tube site, minor bleeding, tube dislodgement or blockage, and, less commonly, leakage of stomach contents around the tube or injury to a nearby structure during placement. Antibiotics are often given around the time of the procedure to reduce infection risk. Serious complications are uncommon, and the large majority of patients tolerate the procedure and the tube well.
Correct patient selection between endoscopic and radiological placement, careful pre-procedure planning to identify a safe access route, and precise, image-guided technique during the procedure itself all contribute to a well-functioning, low-complication feeding tube. This is why percutaneous radiological gastrostomy is best performed by an interventional radiology team with specific experience in the technique, working closely with the referring physician, speech and language therapist, and dietitian involved in planning the patient's overall nutritional care.
Both place a feeding tube into the stomach through the skin. A PEG is placed using an endoscope passed through the mouth, while a PRG or RIG is placed entirely using ultrasound and X-ray guidance, without any endoscope — useful when passing an endoscope isn't possible or carries higher risk for a particular patient.
It's done under local anaesthesia, with sedation if needed, so most patients tolerate it well with only mild discomfort at the site afterward.
This varies by local protocol, but feeding through the tube can typically begin within several hours to the following day after placement, once the team is satisfied the tube is functioning correctly.
Not necessarily — for many patients, such as after a stroke or during cancer treatment, the tube supports nutrition temporarily and can be removed once safe swallowing recovers. For some progressive conditions, longer-term use may be needed, and this is reviewed individually over time.
Care mainly involves keeping the site clean, flushing the tube regularly to prevent blockage, and checking it's positioned correctly. Patients and caregivers are taught this before discharge, along with the warning signs that should prompt a call to the treating team.
Book a consultation with Dr. Giragani to discuss the right feeding option.