Rajeev Jayadevan

The effect of aspirin on hospital length of stay and complications after percutaneous endoscopic gastrostomy (PEG)

Purpose: With an aging population, the number of PEGs performed is increasing. Physicians are under pressure to reduce the hospital length of stay. Usual practice is to hold aspirin for at least 5 days prior to PEG due to the anti-platelet effect which could increase length of stay. This study compares the frequency of complications and hospital length of stay for PEG between patients taking aspirin and those who do not.

Is melanosis coli a red flag|[quest]|

Purpose: To determine the possible association between melanosis coli and colorectal neoplasia.

A tale of two cysts

Introduction: Lichen planus (LP) is a disorder of unknown etiology, usually affecting the skin, mucous membranes, hair and nails. LP involving the esophagus is a rare phenomenon. Case Report: A 63 year old female referred with retrosternal discomfort, dysphagia, and pain radiating to her back and shoulders, with failure of proton pump inhibitor therapy for erosive esophagitis. Her medical history was significant for Grave’s disease, migraines relieved with NSAIDS, and hypertension. Her physical exam revealed large white plaques on her buccal mucosa and posterior pharynx. Endoscopy revealed severe ulcerative esophagitis. Oral lesion biopsies and immunoflorecence studies were positive for LP. The patient failed treatment with steroids, 6-mercaptopurine and mycophenolate mofetil and is currently undergoing a course of cyclosporine. Discussion: The majority of patients with esophageal lichen planus (ELP) are asymptomatic. ELP commonly occurs in middle aged or elderly women who present with a history of dysphagia with associated oral or cutaneous lesions on physical exam. ELP is usually located in the proximal part of the esophagus. The diagnosis is difficult to establish since the lesions are deep within the tissues, and biopsies are often negative. ELP is a chronic disease and difficult to manage with frequent relapses. The cause of ELP is unclear, but our patient’s history of hypertension and NSAIDs may have been contributing risk factors.