It can be placed under endoscopic control or by the use of X - ray.
Having passed the needle through the abdominal wall, the guidewire is passed into the stomach and grasped
with endoscope snare. Keeping the guidewire tight, the four successively larger dilators are passed over the wire into the stomach to create the tract.
The last is removed and the trocar introducer and split sheath is inserted into the stomach. The gastrostomy tube is then inserted as above. After the position of the tube is checked internally the sheath is split and removed.
Having cleaned the tube the skin disc can be advanced to the skin. Note the position mark as a reference for tube migration.
Caution: lt is important that the skin disc does not secure the tube too tightly as this may cause tissue necrosis or erosion of the stomach wall. There should be a small amount of in and out play.