 After informed consent was obtained, the patient was brought to the endoscopy suite.  He was placed in the supine position and was given IV sedation by the Anesthesia Department.  An EGD was performed from above by Dr. X.  The stomach was transilluminated and an optimal position for the PEG tube was identified using the single poke method.  The skin was infiltrated with local and the needle and sheath were inserted through the abdomen into the stomach under direct visualization.  The needle was removed and a guidewire was inserted through the sheath.  The guidewire was grasped from above with a snare by the endoscopist.  It was removed completely and the Ponsky PEG tube was secured to the guidewire.