Distend the stomach with air, confirm no colon or liver lies in the path, fix the stomach with T-fasteners, then puncture and place the tube under fluoroscopy — with a contrast check before the first feed if in doubt.
Orient first
- Used when endoscopic gastrostomy is not possible (head and neck cancer, motor neurone disease).
- Interposed transverse colon is the main risk; a prior CT shows it.
- Complications: peritonitis from leak, tube dislodgement, bleeding, buried bumper.
Acquire the study
- Nasogastric tube for insufflation; review of prior CT for the path; fluoroscopy with pulsed low-dose settings.
The manoeuvre
- Air insufflation via the nasogastric tube: distended stomach against the anterior wall.
- Mark the left upper quadrant entry point avoiding the colon and the left lobe of the liver (ultrasound for the liver edge).
- T-fastener gastropexy, then needle puncture and guidewire; tube balloon inflated in the stomach.
- Contrast injection through the tube: gastric rugae outlined, no intraperitoneal leak; record fluoroscopy time.
What confirms it
- Tube balloon within the stomach with contrast outlining gastric rugae and no leak.
What licenses you to exclude it
- Not applicable — a procedure.
The classic misread
- Puncturing through interposed colon.
- Calling expected small pneumoperitoneum after RIG a complication.