Hachem Jack J, Pham Thu, Banerjee Ankona, Noel James
Department of Pediatric Gastroenterology, Children's Hospital of San Antonio, San Antonio, TX, USA.
Department of Pediatric Gastroenterology, Baylor College of Medicine, Houston, TX, USA.
Pediatr Gastroenterol Hepatol Nutr. 2025 Mar;28(2):86-92. doi: 10.5223/pghn.2025.28.2.86. Epub 2025 Mar 5.
Gastrostomy granulomas frequently occur in pediatric patients with gastrostomy tubes, yet there is a notable lack of comprehensive data on the efficacy and safety of various treatment modalities. Commonly used treatments, such as silver nitrate, are often painful and require frequent clinic visits, posing challenges for patients and families. Additionally, research on home-based treatments is limited, despite their potential to offer more convenient and less painful alternatives. This study addresses the need for well-designed comparisons of different treatment options.
We conducted a prospective, open-label study at the Children's Hospital of San Antonio, enrolling 36 pediatric patients aged 6 months to 17 years with gastrostomy tubes. Patients were randomized into two groups: one treated with topical silver nitrate and the other with table salt, excluding those on chemotherapy or with immunologic disorders. Granuloma sizes were measured at the study's start with blinded physicians analyzing photographs to assess size reduction, and parent satisfaction surveys were conducted to evaluate treatment acceptability and side effects.
The median reduction in granuloma size was significantly greater in the table salt group (3.12 mm) compared to the silver nitrate group (2.25 mm) (Wilcoxon -value=0.04). Parental satisfaction and confidence were high in both groups, with minor, self-limited skin irritation reported as a side effect.
The study suggests that table salt could be a feasible, non-inferior, and cost-effective alternative to silver nitrate for treating gastrostomy granulomas in pediatric patients. Further research with a larger sample size is necessary to validate these findings.
胃造口术肉芽肿在接受胃造口管置入的儿科患者中经常出现，但目前关于各种治疗方式的疗效和安全性缺乏全面的数据。常用的治疗方法，如硝酸银，通常会引起疼痛，并且需要频繁到诊所就诊，给患者及其家庭带来挑战。此外，尽管家庭治疗有可能提供更方便且痛苦较小的替代方案，但相关研究却很有限。本研究满足了对不同治疗方案进行精心设计比较的需求。
我们在圣安东尼奥儿童医院进行了一项前瞻性、开放标签研究，招募了36名年龄在6个月至17岁之间且带有胃造口管的儿科患者。患者被随机分为两组：一组接受局部硝酸银治疗，另一组接受食盐治疗，排除正在接受化疗或患有免疫性疾病的患者。在研究开始时测量肉芽肿大小，由 blinded 医生分析照片以评估大小缩小情况，并进行家长满意度调查以评估治疗的可接受性和副作用。
食盐组肉芽肿大小的中位数减少量（3.12毫米）显著大于硝酸银组（2.25毫米）（Wilcoxon检验值 = 0.04）。两组家长的满意度和信心都很高，报告的副作用为轻微、自限性的皮肤刺激。
该研究表明，对于治疗儿科患者的胃造口术肉芽肿，食盐可能是一种可行、非劣效且具有成本效益的硝酸银替代方案。需要进行更大样本量的进一步研究来验证这些发现。
