PUG for IR

percutaneous ultrasound gastrostomy; an alternative to PEG or PRG


PUG is an ultrasound-based procedure for inserting gastrostomy tubes which can be quickly and easily performed without ionizing radiation.  It employs readily available medical devices such as ultrasound, feeding tubes, guide-wires and dilators. 

Ultrasound delivers the real-time imaging during percutaneous access to the stomach, without ionizing radiation. PUG uniquely enables safe gastrostomy tract formation by seeing critical anatomy. Maximizing your procedural efficiency is good for you, your patient, and your hospital. By providing guidewire access from the stomach (percutaneously) to mouth, PUSH gastrostomy can save precious time and effort – estimated at a 33-50% reduction in procedure time.Depending on your institution, IR procedures may be in the IR suite or at the bedside (e.g., ICU). PUG maximizes your IR suite efficiency by either reducing gastrostomy time in suite, or moving gastrostomy to the bedside.


Step 1

Following orogastric placement of the balloon catheter, bring the external magnet into the field to achieve coaptation. Introducing fluid into the balloon catheter then enables ultrasound visualization.  

Ultrasound Confirmation.png

Step 2

Using standard ultrasound techniques, find a safe gastrostomy tract, avoiding organs and vasculature. With the external magnet, make minor placement adjustments as needed. Target balloon with needle under ultrasound guidance. 

Gtube Placement.png

Step 3

Once the needle is placed, insert the guidewire and retract the balloon/guidewire pairing in tandem out through the mouth. Place the gastrostomy tube over the guidewire using standard PUSH technique. Dilate and secure gastrostomy tube. [cadaver image shown]