📖 What is PRG?
A percutaneous radiological gastrostomy (PRG), also called RIG (radiologically inserted gastrostomy), is a feeding tube placed directly through the anterior abdominal wall into the stomach under fluoroscopic guidance. It provides enteral nutrition when oral feeding is impossible or inadequate — without requiring endoscopy or general anaesthesia.
At Cochin AP-HP, PRG is the preferred alternative to PEG (percutaneous endoscopic gastrostomy) in patients with head and neck tumours, stenotic oesophageal cancer, or where endoscopy is not feasible. Performed under local anaesthesia as a day procedure.
🎯 Indications
- Head and neck cancer — during or after radiotherapy/surgery when swallowing is impaired
- Oesophageal cancer — tumour preventing PEG insertion
- Neurological dysphagia — stroke, ALS/MND, Parkinson's, dementia
- Failed PEG — where endoscopy is not feasible
- Pre-operative nutritional optimisation in malnourished patients
🔧 Procedure
Nutritional assessment. CT abdomen to assess gastric position and plan puncture route. Blood tests.
Nasogastric tube for gastric air insufflation. Local anaesthesia at the puncture site.
T-fasteners placed to anchor the stomach to the anterior wall — critical safety step before tube insertion.
Seldinger technique through the anterior wall. 14–18 Fr gastrostomy tube inserted and secured. Fluoroscopic contrast check confirms intragastric position.
Usually begins 4–6 hours post-procedure. Community nursing team provides tube care instructions.