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Constipation is when a person has infrequent or hard to pass bowel movements, has hard stools, or feels like their bowel movements are incomplete. Most of the time, constipation can be treated medically. It may be normal to have some constipation at times. In most cases, constipation is a symptom rather than a disease. Common causes of constipation include dietary choices, medications, irritable bowel syndrome, poor bowel habits or pelvic floor dysfunction. At home, diet is key. Eat a well-balanced diet with whole-grains, fresh fruits and vegetables. We recommend drinking plenty of water and ensuring an adequate amount of fiber in the diet. Exercise regularly. Set aside time after breakfast or dinner to use the restroom. Go use the restroom when the urge strikes rather than ignoring it. When these daily habits may be insufficient, adding supplemental fiber, stool softeners or laxatives may be beneficial.

ERCP is one of the most technically demanding and high-risk procedures performed by GI endoscopists. It requires significant focused training and experience to maximize success and to minimize poor outcomes. ERCP has evolved from a purely diagnostic to a predominantly therapeutic procedure. ERCP and its ancillary interventions are effective in the non surgical management of a variety of pancreaticobiliary disorders, most commonly the removal of bile duct stones and relief of malignant obstructive jaundice. The American Society for Gastrointestinal Endoscopy (or ASGE) has published specific criteria for training and granting of clinical privileges for ERCP, which detail the many skills that must be developed to perform this procedure in clinical practice with high quality. EUS has become integral to the diagnosis and staging of GI and mediastinal mass lesions and conditions. EUS-guided FNA and FNB (or fine needle aspiration and fine needle biopsy) enables for sampling to further analyze these conditions.

An endoscopic ultrasound (or EUS) is a procedure to examine the inside of the digestive tract. This is done by using a thin, flexible tube with a camera and light on the end, as well as an ultrasound probe that sends out sound waves to produce images of your organs, tissues and blood vessels. During the EUS, your endoscopist may also perform fine-needle aspiration or biopsy, which is done to remove a small sample of fluid or tissue. This sample goes to a pathology lab to be examined further for signs of disease, including abnormal or cancer cells. Before the EUS, your healthcare provider will discuss with you any changes in medications (such as blood thinners) that may need to be held. You should not eat or drink for eight hours prior to the test. The procedure typically lasts no longer than 30 minutes. You'll be under sedation while the procedure takes place. You shouldn't feel any pain during or after the procedure. Upon awakening, you'll be in the recovery area until you're ready to be discharged home with your driver. Prior to leaving, your endoscopist will be able to discuss the findings of the exam.

Anal fissures are primarily treated with medication. It's traditionally a topical ointment applied three times daily for six-weeks. This allows the anal sphincter to relax and the overlying skin to heal on its own. This is effective for symptom management more than 80% of the time. Anal fissures can recur, and a repeat course of medication is effective therapy. If fissures are refractory to the ointment, our next step is injecting Botox® into the anal sphincter. This allows for prolonged relaxation of the anal sphincter and additional time for the tear to heal. Botox® cures approximately 70% of fissures that do not respond to medication therapy. Finally, if the previous measures fail, there are surgical options that can be explored.

Endoscopic ultrasonography is an endoscopic test similar to upper or lower endoscopy that involves a dedicated ultrasound probe at the end of the scope to allow for visualization of structures outside the GI tract. Typically, EUS is used for cancer diagnosis and staging, assessment of lymph nodes, and evaluation of pancreatic diseases and small lesions under the surface of the lining of the GI tract. While EUS is a minimally invasive procedure with an endoscopist who has undergone appropriate training, it can be extremely useful in diagnosing and assessing certain conditions if or when other imaging methods may not be as useful.