Patients with advanced ALS are often involved in swallowing, unable to eat, and have inadequate nutritional support. Experienced large tertiary hospitals often recommend that patients have a percutaneous gastrostomy. The stomach is attached to the skin of the body, and 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 up directly into the stomach directly into the chyme. This procedure is fairly simple and less expensive ($2-3,000). However, this procedure is recommended to be done when the patient’s body is in good condition. Some patients who have the procedure done late in life may stop breathing after the procedure due to their poor health condition. You can discuss the details with an experienced specialist or doctor who has studied motor neuron disease.