Granulation Tissue

Build up of Granulation Tissue
I also have a question regarding a continuous buildup of granulation tissue around the gastrostomy tube. I have had it cauterized with silver nitrate and surgically cut several times since I have had the tube, with no success. I have tried numerous antibiotic ointments, oral antibiotics, IV antibiotics and daily cautery after surgically being cut to prevent it from growing back. But nothing helps. It is chronically infected and irritated. The only other option suggested to me, was to have the tube removed to let it heal and reinsert it at a different site, but there is no guarantee that it will help. I would appreciate any feedback.

Carol Pelissier
280 Elgin Ave.,
Manchester, NH 03104,
(603) 625-2362

Unfortunately, granulation tissue is very common. It can occur when GI secretions leak up and around the outside of the tube. So making sure you have a "snug fitting" tube is important. Apart from this, there really is not much more that can be done except to continue to cauterize with silver nitrate. I am afraid that it is a problem that is likely to continue to reoccur. Carol is correct in stating that the tube can be resited, but there is no guarantee that granulation will not reoccur.

Painful Scar Tissue Around Stoma
I am looking for some help with painful scar tissue in my stoma. Apparently when I was first on enteral, my surgeon placed a Foley catheter and anchored it in a few places, stitching it to my stoma area. After two months, he took my Foley catheter and stitches out and put in a Mic-key, which I currently use as my J-tube. Nine months later, I now have three very painful raised scars which cause me to feel a sharp pain as the tube starts moving around. (Since I have a motility disorder, my tube moves around.) My dermatologist tried to shrink these scars by injecting them with Triamcinolone Acetonide ointment. I am going to try a pain clinic to see if they can anesthetize the nerves in my stoma. I am wondering if I would be better off if they just removed these scars?

Cathy Tokarz
Bloomingdale, IL,

Scars around J-tube sites are common, and unfortunately, there isn't much more that can be done. Hollister has a clamp which can be used to anchor the tube and prevent it from moving around, which may help. I wish I had more to offer.

Two Suggestions for Granulation Tissue
In the March/April LifelineLetter Tube Talk column, I saw the discussion about granulation tissue. You may not be aware of something called Kenalog or Triamcinalon cream. It is a wonderful alternative to silver nitrate, as there is no pain or discomfort involved in the application. When my son, Sean, gets granulation tissue, we apply a very tiny amount of this directly to the tissue, 4x per day, and usually within a day or two it is completely gone. It is a cortizone type cream, so you need to be careful not to apply it for more than a few days running, as it thins the skin surrounding the stoma. It comes in .1% and .5% concentrations.

We have also found that cleaning the area around the stoma with plain soap and water seems to help control the growth of the granulation tissue. Back when we cleaned with diluted hydrogen peroxide he was more likely to grow granulation tissue, and since switching he has not had a problem but the one time he had to have a g-tube instead of a button. I hope this helps.

Heidi Forney
Sweet, Idaho

I have one suggestion for granulation tissue. Talk a short piece of toilet tissue (1 to 2 squares, depending upon how "plush" it is.) Roll it up into a string effect and then wrap that around the g-tube. Depending upon the amount of leakage, you may need to change it one or more times a day. It does two things - First it keeps the button snug. (If your like me - the fit for your button can vary within one day!) and second it absorbs any fluid that may be leaking out. If you do have this type of leaking, it is particularly important to change the tissue a few times a day. Since I started doing this I rarely have much granulation tissue build up.

Ann DeBarbieri
Albany, NY

More On Granulation Tissue

In the Tube Talk column in May/June LifelineLetter, Ann DeBarbieri had a good suggestion for discouraging the granulation tissue formation around the G-tube. I wanted to tell her and the rest of the Oley members about a product that my daughter uses. It is called Sof-wick I.V. sponge, made by Johnson and Johnson. It is a sterile 2" x 2" six-ply pad with a split half way down the middle. We have found these to fit perfectly around the stem of the G-tube. They are very soft and absorbent. If we need to apply medicinal creams to the area these are helpful to keep the meds on the skin and not the clothes. Also if the tube is leaking they will help to absorb that too. One last thing we use them for is when there is a crust formed on the skin around the tube. I wet the pad with warm water and apply it for about 10 minutes and the crust is dissolved with no trauma to the area.

- Tracy Cox

[Editor’s Note: If you have any questions, or if your tube continues to leak, call your physician/ET nurse.]

Minimize the Pain of Silver Nitrate

If you’re like me, using silver nitrate to reduce tissue build-up around your stoma site can be very painful. One suggestion is to ask your physician about numbing the area first with a drop or two of 2% Lidocaine. It should be left on the tissue area for a couple of minutes, then dabbed off, before the silver nitrate is applied. I find it much less traumatizing and more comfortable to deal with. The 2% Lidocaine may be prescription only, but a little goes a long way and certainly cuts down on the pain. (Note: because you use so little each time, it is wise to store the Lidocaine in a dark area at room temperature.)

— Barbara Witt
Port St. Lucie, FL
(561) 344-8908