has reported histologic evidence of esophageal lichen planus in 50% of patients with oral lichen planus detected by using high-magnification chromoendoscopy. 6 The role of surveillance of patients with oral or esophageal lichen planus is not defined, but endoscopic surveillance may be considered. There are no treatment guidelines for esophageal lichen planus. Reported treatment methods have included sys- temic steroids, cyclosporine, topical tacrolimus, and endo- scopic dilation and steroid injection. 1-3,5,7 Treatment with systemic steroids has a reported response rate of up to 74%; however, relapse rates after steroid withdrawal may be as high as 85%. 1 Esophageal perforation was reported with endoscopic dilation in 1 of 5 patients with esophageal lichen planus in one case series. 5 We advocate consider- ation of swallowed topical steroids for treatment of esoph- ageal lichen planus. In conclusion, we report the first case of treatment of esophageal lichen planus with swallowed fluticasone with complete clinical and endoscopic response. A high index of suspicion is needed to diagnose esophageal lichen planus, and consideration should be given to surveillance for squamous cell carcinoma of the esophagus. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. REFERENCES 1. Westbrook R, Riley S. Esophageal lichen planus: case report and literature review. Dysphagia 2008;23:331-4. 2. Katzka DA, Smyrck TM, Bruce AJ, et al. Variations in presentations of esophageal involvement in lichen planus. Clin Gastroenterol Hepatol. Epub 2010 May 12. 3. Wedgeworth EK, Vlavianos P, Groves CJ, et al. Management of symptom- atic esophageal involvement with lichen planus. J Clin Gastroenterol 2009;43:915-9. 4. Bermejo-Fenoll A, Sanchez-Siles M, López-Jornet P, et al. Premalignant nature of oral lichen planus: a retrospective study of 550 oral lichen pla- nus patients from south-eastern Spain. Oral Oncol 2009;45:e54-6. 5. Chryssostalis A, Gaudric M, Terris B, et al. Esophageal lichen planus: a series of eight cases including a patient with esophageal verrucous car- cinoma: a case series. Endoscopy 2008;40:764-8. 6. Quispel R, van Boxel OS, Schipper ME, et al. High prevalence of esopha- geal involvement in lichen planus: a study using magnification chro- moendoscopy. Endoscopy 2009;41:187-93. 7. Chaklader M, Morris-Larkin C, Gulliver W, et al. Cyclosporine in the man- agement of esophageal lichen planus. Can J Gastroenterol 2009;23: 686-8. Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. Reprint requests: Jason K. Hou, MD, Baylor College of Medicine, 1709 Dryden Road, Suite 8.40, Houston, TX 77030. Copyright © 2011 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2010.09.032 PEG rescue with gastropexy after early tube withdrawal: an application of natural orifice transluminal endoscopic surgery (with video) Bruno da Costa Martins, MD, Jonas Takada, MD, Fábio Shiguehissa Kawaguti, MD, João Paulo Aguiar Ribeiro, MD, Fábio Yuji Hondo, MD, Marcelo Simas de Lima, MD, Carla Zanellatto Neves, MD, Caio Sérgio R. Nahas, MD, Carlos Frederico Sparapan Marques, MD, Paulo Sakai, MD, PhD, Fauze Maluf-Filho, MD, PhD São Paulo, Brazil PEG has become the modality of choice for providing long-term enteral access to patients in need of nutritional support. Although considered to be safe, PEG placement is associated with complications, one of the most serious being dislodgment of the tube before the formation of a mature tract. 1 PEG dislodgment occurring 1 week after the procedure carries a serious risk of free perforation and peritonitis; surgical treatment for this condition by explor- atory laparotomy or laparoscopy is usually advised. Natural-orifice transluminal endoscopic surgery (NOTES) has emerged as a new tool in this setting. It is presumably less invasive than laparoscopy, although some drawbacks limit its use. PEG dislodgment with gastric detachment rep- resents a suitable scenario for NOTES, because there is no concern about closing the defect. We present a case of early PEG withdrawal with peritoneal spillage man- aged with NOTES exploration through the endoscopic site. CASE REPORT A 92-year-old male patient with senile dementia and swallowing impairment caused by a head and neck tumor Brief Reports www.giejournal.org Volume 74, No. 3 : 2011 GASTROINTESTINAL ENDOSCOPY 709