The authors evaluated their uncontrolled, retrospective experience with 33 patients with ALS with erect or supine forced vital capacity less than 50% predicted who underwent attempted percutaneous endoscopic gastrostomy (PEG) tube placement using noninvasive positive pressure ventilation and oxygen support and conscious sedation anesthesia. Gastrostomy tubes were successfully placed in all patients. Mean survival was 211 days with most patients (67%) surviving more than 180 days. Forced vital capacity at the time of PEG placement did not predict survival.