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Introduction:Percutaneous endoscopic gastrostomy (PEG) tube placement in ALS patients with impaired respiratory function is associated with an increased risk of peri-procedural and post-interventional complications. It was the aim of the study to analyze peri- and postinterventional complications and survival after PEG tube placement under non-invasive ventilation (NIV) in ALS patients with various degrees of respiratory impairment. Materials and Methodology: Twenty-six patients were included in this retrospective case study. Prior to PEG tube placement, training with ventilator support via an oronasal mask was performed with ALS patients on the pneumology ward. PEG placement was then performed under continuous NIV. Forced vital capacity (FVC), sniff nasal inspiratory pressure (SNIP) and demographic data were assessed. Complication rates and 1-month and overall survival rates were analyzed. RESULTS: There were no deaths within 24 hours after PEG placement. One patient died within the first month. The mean survival rate after PEG was 12±10 months (range 0.6 months to 42 months). There was no difference in post-PEG survival between patients with moderately (>50%) and severely (<50%) impaired FVC. CONCLUSION: In the presented case series, PEG tube insertion was associated with minimal peri- and post-procedural complications. The low complication rate might be due to the systematic use of procedural NIV in ALS patients.