Gastrostomy for nutritional support can be performed radiologically when endoscopic technique is not possible. In patients with complete obstruction of the upper digestive tract, the radiological technique in its conventional method may not be possible, as insertion of naso-gastric tube for gastric insufflation is not always successful. We reviewed our experience of gastrostomy insertion in nine such patients after failure of the conventional method. In seven of the nine patients, initial gastric puncture was achieved with a 22G needle under direct ultrasound visualisation. In the remaining two patients, initial puncture was made into locules of gas in the stomach with fluoroscopy. The stomach was then distended with air and a gastrostomy tube inserted by conventional technique. We conclude that percutaneous gastrostomy can be undertaken safely even in the presence of complete obstruction of the upper digestive tract and recommend this technique in this selective group of patients.