G/GJ tubes: Granulation tissue

Granulation tissue is the new tissue that forms when a wound is healing. It is also the extra tissue that grows around the feeding tube. It is usually bumpy or swollen tissue that is shiny or wet, bleeds easily and can be painful. Granulation tissue is the most common skin issue that occurs in children with G or GJ tubes.

Signs of granulation tissue

Granulation tissue

Granulation tissue generally appears as follows:

• pink to dark red tissue, but it does not spread like an infection
• open, wet looking or shiny
• bleeds easily
• bubbly and puffy
• can be painful

Causes of granulation tissue

Granulation tissue can form for several different reasons.

• The feeding tube moves in and out of stoma. This can happen when a low-profile tube is incorrectly sized.
• The stoma is wet. This could be from excessive leaking or because the stoma is covered with a dressing, so it is not able to dry completely.
• There is too much pressure on the stoma. This may be because a low-profile tube is too tight, the tube has been accidentally pulled out or there was a recent tube change.
• There has been physical trauma to the stoma, such as the tube being pulled out.
• Granulation tissue may form when there is an infection. Granulation tissue is not the same as an infection.
• The stoma will usually look worse and granulation tissue may form when a child is sick, for example with a respiratory illness or gastroenteritis, of if they are recovering from surgery.

Treatment of granulation tissue

Your child's health-care provider can recommend the best way to manage your child's granulation tissue, based on the treatments in this clinical practice guideline: SickKids Enterostomy Tube Stoma Assessment Clinical Practice Guideline.

Contact your child's health-care provider if the stoma does not improve with treatment or if the granulation tissue gets worse.

How to keep a healthy stoma

Healthy stoma

To keep your child’s stoma healthy, you should:

• Wash the stoma daily with soap and water.
• Allow the stoma to be open to the air. Do not put dressings on the stoma unless your health-care team advises you to do so.
• Keep the stoma dry. Do not apply ointments or creams unless your health-care team advises you to do so.
• Always secure the feeding tube well to avoid friction against the skin.
• Avoid too much movement of the tube in the tract.
• Address stoma leakage as soon as possible.
• Prevent infection.
• For a low profile tube :
• Make sure your child’s tube fits properly.
• Check the volume of the tube’s balloon weekly.
• If you think your child’s balloon-type G tube is too loose or too tight, contact your G tube team to re-measure the size of the tube.

At SickKids

If your child is a SickKids patient, contact the G Tube Resource Nurse with any concerns.

G Tube Resource Nurse contact info:

Phone: 416-813-7177

Email: g.tubenurse@sickkids.ca