Patients with advanced ALS often involve swallowing function, cannot eat, and have insufficient nutritional support. Experienced large tertiary care hospitals often recommend that patients undergo a percutaneous gastrostomy. The stomach is attached to the skin of the body. If the patient cannot eat, a small hole can be made in the stomach, a tube can be attached, and later, food can be ground directly into surimi and pumped directly into the stomach. This procedure is fairly simple and less expensive (2-3 thousand dollars). However, it is recommended that this procedure be done when the patient’s body is in good shape; some patients have the procedure done late in life and may stop breathing after the procedure due to poor health. You can discuss this with a specialist or doctor who is experienced in studying motor neuron disease.