Granulation Tissue Associated with Pediatric Gastrostomy Tubes

Student Researcher:
Avery Crocker

Supervisor / Principle Investigator:
Dr. William Craig

MD Class of 2020


Gastrostomy tubes are nutritional support devices, inserted through the abdominal wall into the stomach. Gastrostomy tubes are commonly utilized in chronically ill pediatric patients with short bowel syndrome, neurological disease, prematurity, congenital heart disease, and oncologic disease.

A complication of an existing stoma is granulation tissue. Granulation tissue formation is generally attributed to improperly sized devices, resulting in subsequent leakage, excessive inflammation and healing response. The ensuing and bothersome discharge, pain and infection may lead to eventual surgical debridement.

Granulation tissue at the gastrostomy site is of particular interest to us. The incidence of leakage and granulation tissue development at the stoma is contended among the literature. This adverse effect is often inconsistently reported in outcome studies, potentially due to a lack of a definitive grading system for quantification. Furthermore, it is not always considered a complication and documented.

To determine the prevalence of granulation tissue, we initiated a prospective cohort study in the Pediatric Home Nutrition Support Clinic at the Stollery Children’s Hospital. Patients with a pre-existing G-Tube are approached for the study, and a CRF completed collecting information regarding the presence of granulation tissue, suspected infection, care of the stoma, prior treatments and possible cofounding factors.

The data collected will be analyzed and the incidence of granulation tissue associated with gastrostomy tubes at this clinic will be calculated. Demographic and descriptive variables will be described using appropriate parametric or non-parametric techniques. Additionally, a logistic regression will be used to determine the related risk factors for the development of this granulation tissue, including patient behaviours, stoma condition, demographics and treatments attempted past and present. Testing for interaction and confounding will be completed. A P-value less than 0.05 will be considered significant.

We anticipate the incidence of granulation tissue at our institution will be higher than reported in the literature, and associated with factors such as improperly sized devices and subsequent leakage.