Abstract
Introduction: Enteral feeding via Percutaneous Endoscopic Gastrostomy PEG is a widely used method to handle nutritional problems in children with a variety of disorders. Problems in the ability to swallow due to neurological impairment, difficulties in the proper intake of calories in metabolic diseases or continuous enteral administration of nutrition in gastroenterological diseases are typical reasons for PEG placement. In about one third to one fourth of the patients hypergranulation tissue (caro luxurians) develops at the PEG insertion site 1, 2sometimes with subsequent hypersecretion and bleeding or recurrent infections. Mostly frequent applications with silver nitrate solution are used to treat these cases. In order to faciliate handling and to minimize visits at medical facilities for the patients we used contact-cryotherapy, typically applied to superficial cutaneous hemangiomas, to treat only such patients with fast growing or bleeding hypergranulation tissue (10 patients, 2–13 years). Methods: Prior to starting the application of cryotherapy on hypergranulation tissue tests were performed in cooperation with PEG manufacturers to guarantee the integrity of the PEG tube in case it had been cooled through the surrounding tissue or directly come into contact with the ultracold cryoprobe. On the patient the PEG insertion site was cleaned with octenidine hydrochloride and anaesthesized with lidocaine/prilocaine cream. Afterwards the iced cryoprobe (−196° C) was pressed onto the tissue for 10 seconds, multiple times, if indicated. Results: Experiments with PEG tubes showed no damage even after directly freezing the plastic in liquid nitrogen if not being bent in this state. So the cryotherapy could be regarded as safe as far as the integrity of the tube was concerned. Most patients needed a single session with a subsequent decrease in the hypergranulation tissue. Only two patients received multiple sessions over a period of about two years due to recurrent infections. In these cases each cryosession resulted in a marked improvement of the lesion. Conclusion: The cryotherapy seems to be a valuable method in children with PEG and hypergranulation tissue. The disadvantage of being a little painful can be antagonized easily with anaesthetic cream. Advantages lie in the low frequency of relapses and in the low frequency of treatment sessions in comparison to silver nitrate applications.
Published Version
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