Makindo Medical Notes

A Radiologically Inserted Gastrostomy (RIG), also known as a Percutaneous Radiologic Gastrostomy (PRG), is a feeding tube placed directly into the stomach through the abdominal wall under imaging guidance. It is commonly performed when a patient cannot meet nutritional needs orally, e.g. due to neurological disorders (stroke, MND, MS), head & neck cancers, or severe swallowing difficulties. 💡 Clinical pearl: In the UK, RIG is often chosen over PEG (endoscopic gastrostomy) in patients with unsafe sedation or difficult endoscopic access.

🛠️ Procedure Overview

1. Preparation:
   • Patient is usually sedated or given local anaesthesia to minimise discomfort.
   • Radiologist uses fluoroscopy or ultrasound to identify the stomach and adjacent organs.
   • Nasogastric tube may be inserted first to insufflate the stomach with air → improves visibility and safety.
2. Insertion of the Tube:
   • Small incision made in the abdominal wall.
   • A needle punctures the stomach under radiological guidance → a guidewire is introduced.
   • The gastrostomy tube is passed over the wire and positioned inside the stomach.
   • The external end is secured with a fixation device to prevent dislodgement.
3. Post-Procedure Care:
   • Insertion site monitored closely for bleeding, leakage or infection.
   • Feeding usually begins after 4–6 hours once placement is confirmed and patient stable.
   • Care instructions given for cleaning, flushing, and troubleshooting tube blockage.

🌟 Benefits of RIG

• ✅ Minimally invasive compared to open gastrostomy.
• ✅ Imaging guidance ensures accurate and safe placement.
• ✅ Provides reliable long-term nutritional support in complex patients.
• ✅ Particularly useful when PEG insertion is unsafe or not possible.

⚠️ Risks and Complications

• 🦠 Infection at insertion site (cellulitis, peritonitis).
• 💉 Bleeding, haematoma, or injury to adjacent viscera (colon, liver, spleen).
• 🔄 Tube dislodgement, blockage, or leakage of gastric contents.
• ⚡ Aspiration during or after procedure.
• 📉 Rare: peritonitis from leakage, buried bumper syndrome.

💡 Clinical pearl: Always check for absolute contraindications (uncorrected coagulopathy, peritonitis, inability to access stomach) before proceeding. In ALS/MND, timing of RIG placement is crucial → early placement improves tolerance and reduces peri-procedural risk.

PEG vs RIG: Comparison

💡 Teaching Tip: In the UK, PEG is standard for long-term enteral feeding. Use RIG if endoscopy is not possible or unsafe. Always discuss with MDT (gastroenterology, radiology, dietetics, speech therapy) before insertion.