Commun salt application as a treatment for percutaneous endoscopic gastrostomy periostomal granuloma
DOI:
https://doi.org/10.47892/rgp.2024.443.1714Keywords:
Gastrostomy, Granuloma, Postoperative complications, Therapeutics, SaltsAbstract
Percutaneous endoscopic gastrostomy (PEG) is an important procedure for nutrition delivery, and one that is often associated with complications. The formation of granulation tissue or periostomal granuloma is a chronic minor complication associated with gastrostomy, being more frequent in geriatric patients, but the therapeutic experience in pediatric patients is better known. We present the case of a 94-year-old female patient, diagnosed with Alzheimer's dementia with severe motor and cognitive impairment, who presents significant malnutrition and severe dysphagia. In treatment with rivastigmine, sertraline, and trazodone, in addition to muscle relaxant. She has been a gastrostomy user for 2 years due to severe motor and swallowing compromise. In the past 1 year ago with presence of ring granuloma, without bleeding. It was decided to treat with common salt as the first line of treatment since there was no bleeding. The primary caregiver was instructed on the details of how to apply common salt on the granuloma at home. The patient showed complete resolution of the granuloma within three days of application with no recurrence at follow-up 12 months after the initial evaluation, and without requiring a tube change. PEG-associated granuloma is a frequent minor chronic complication in adult gastrostomy users. The use of common salt is an effective, rapid and safe therapeutic alternative to consider in these patients.
Downloads
Metrics
References
Yuruker S, Koca B, Karabicak I, Kuru B, Ozen N. Percutaneous Endoscopic Gastrostomy: Technical Problems, Complications, and Management. Indian J Surg. 2015;77(Suppl 3):1159-64. doi: 10.1007/s12262-015-1227-6.
Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: Indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739-51. doi: 10.3748/wjg.v20.i24.7739.
Azılı C, Karabacak H, Balas Ş, Apaydın M, Tamam S, Çulcu S, et al. Comparison Between Geriatric and Non-geriatric Patients in the Development of Complications After Percutaneous Endoscopic Gastrostomy. Eur J Geriatr Gerontol. 2023;5(2):144-149. doi: 10.4274/ejgg.galenos.2023.2023-2-2.
Fox D, Campagna EJ, Friedlander J, Partrick DA, Rees DI, Kempe A. National trends and outcomes of pediatric gastrostomy tube placement. J Pediatr Gastroenterol Nutr. 2014;59(5):582-8. doi: 10.1097/MPG.0000000000000468.
Warriner L, Spruce P. Managing overgranulation tissue around gastrostomy sites. Br J Nurs. 2012;21(5):S14-6, S18, S20 passim. doi: 10.12968/bjon.2012.21.Sup5.S14.
Borkowski S. G tube care: managing hypergranulation tissue. Nursing. 2005;35(8):24. doi: 10.1097/00152193-200508000-00014.
National Nurses Nutrition Group. Good Practice Consensus Guideline: Exit Site Management for Gastrostomy Tubes in Adults and Children [Internet]. London: NNNG; 2013 [citado el 7 de enero de 2024]. Disponible en: https://nnng.org.uk/wp-content/uploads/2013/10/Gastrostomy-Exit-site-guidelines-Final.pdf
Toussaint E, Van Gossum A, Ballarin A, Arvanitakis M. Enteral access in adults. Clin Nutr. 2015;34(3):350-8. doi: 10.1016/j.clnu.2014.10.009.
Gal-Or N, Gil T, Metanes I, Nashshibi M, Bryzgalin L, Amir A, et al. Intralesional cryosurgery for the treatment of severe stoma hypergranulation following percutaneous endoscopic gastrostomy. Isr Med Assoc J. 2015;17(4):251-2.
Boeykens K, Duysburgh I, Verlinden W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol. 2022;9(1):e000975. doi: 10.1136/bmjgast-2022-000975.
García VM, Plantagenet-Whyte, García SYI, Pérez FP, Caballero CNMV, Roy PP. Manejo del granuloma con sal común en paciente pediátrico con gastrostomía. Cuid la Salud. 2021;18:5-10.
Lal Halder A, Akter S, Parvez Shahin M, Abdul Baki M, Khan S, Nahar J, et al. Efficacy of Table Salt as a Treatment Option for Umbilical Granuloma in Infants. Am J Multidiscip Res Dev. 2020;2(8):39-43.
Townley A, Wincentak J, Krog K, Schippke J, Kingsnorth S. Paediatric gastrostomy stoma complications and treatments: A rapid scoping review. J Clin Nurs. 2018;27(7-8):1369-1380. doi: 10.1111/jocn.14233.
Daruwalla SB, Dhurat RS. A pinch of salt is all it takes! The novel use of table salt for the effective treatment of pyogenic granuloma. J Am Acad Dermatol. 2020;83(2):e107-e108. doi: 10.1016/j.jaad.2019.12.013.
Tanaka H, Arai K, Fujino A, Takeda N, Watanabe T, Fuchimoto Y, et al. Treatment for hypergranulation at gastrostomy sites with sprinkling salt in paediatric patients. J Wound Care. 2013;22(1):17-20. doi: 10.12968/jowc.2013.22.1.17.
Haftu H, Bitew H, Gebrekidan A, Gebrearegay H. The outcome of salt treatment for umbilical granuloma: A systematic review. Patient Prefer Adherence. 2020;14:2085-2092. doi: 10.2147/PPA.S283011.
Cole TJ, Short KL, Hooper SB. The science of steroids. Semin Fetal Neonatal Med. 2019;24(3):170-175. doi: 10.1016/j.siny.2019.05.005.
Mitchell A, Llumigusin D. The assessment and management of hypergranulation. Br J Nurs. 2021;30(5):S6-S10. doi: 10.12968/bjon.2021.30.5.S6.
Haftu H, Gebremichael TG, Kebedom AG. Salt Treatment for Umbilical Granuloma - An Effective, Cheap, and Available Alternative Treatment Option: Case Report. Pediatric Health Med Ther. 2020;11:393-397. doi: 10.2147/PHMT.S269114.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Juan Sebastián Frías-Ordoñez, William Otero Regino, Johanna Steer Diaz, Hernando Marulanda-Fernández, Elder Otero-Ramos, Lina Otero-Parra
This work is licensed under a Creative Commons Attribution 4.0 International License.
Revista de Gastroenterología del Perú by Sociedad Peruana de Gastroenterología del Perú is licensed under a Licencia Creative Commons Atribución 4.0 Internacional..
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).