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Patient Profile
Patient Name
Mr. Prakash Deshmukh
Age / Gender
58 Years / Male
Consultant
Dr. Vipulroy Dayanand Rathod
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Diagnosis
Early Oesophageal High-Grade Dysplasia in Barrett’s Oesophagus
Past History
Long-standing GERD (10 years) · Barrett’s oesophagus · Normal CT and PET scans
Patient Background
Mr. Prakash Deshmukh, a 58-year-old businessman from Aurangabad, Maharashtra, had lived with long-standing acid reflux for over a decade. A recent CT scan and a PET scan ordered elsewhere to investigate his persistent reflux and mild difficulty swallowing were reported as normal, with no mass or tumour seen. Reassured but still symptomatic, he sought a second opinion. His family searched for the Best Gastroenterologist In Mumbai capable of looking beyond standard scans. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of Endoscopic Ultrasound with over 20,000 EUS procedures, recommended a high-definition diagnostic endoscopy with advanced imaging — a level of scrutiny that cross-sectional scans simply cannot provide for the oesophageal lining.
Symptoms
Chronic acid reflux — heartburn and regurgitation for over 10 years, partly controlled with medication
Mild difficulty swallowing — occasional sensation of food sticking, recently more noticeable
Frequent throat clearing and intermittent cough — attributed to reflux
No alarming symptoms — no weight loss, no bleeding, no anaemia
Normal cross-sectional imaging — a false sense of reassurance after “clean” scans
Diagnostic Method
CT and PET scan review
both reported normal; cross-sectional imaging cannot detect flat, superficial mucosal changes
High-definition upper endoscopy
detailed inspection of the oesophageal lining revealing a Barrett’s segment with a subtle, suspicious flat area
NBI (Narrow Band Imaging) endoscopy
advanced light filtering highlighted abnormal mucosal and vascular patterns invisible on white-light and scans
Endoscopic Ultrasound (EUS)
confirmed the lesion was confined to the superficial mucosa with no deeper or nodal involvement
Targeted biopsies
histopathology confirmed high-grade dysplasia, a pre-cancerous change, with no invasive cancer
Disease Diagnosed
Mr. Deshmukh was diagnosed with high-grade dysplasia arising within Barrett’s oesophagus — a pre-cancerous transformation of the oesophageal lining caused by years of acid reflux. Critically, this flat, superficial change was completely invisible on both CT and PET scans, which only detect bulky masses or established tumours. As a gastroenterology specialist for early gastrointestinal neoplasia, Dr. Rathod recognised that detecting and removing this lesion now would prevent its progression to oesophageal cancer.
Risks if Left Untreated:
Progression of high-grade dysplasia to invasive oesophageal cancer
Need for major oesophageal surgery (oesophagectomy) if found at a later stage
Requirement for chemotherapy and radiotherapy with advanced disease
Significantly reduced survival once the cancer becomes invasive
Treatment Plan
Dr. Vipulroy Rathod performed Endoscopic Mucosal Resection (EMR) to remove the dysplastic segment of the oesophageal lining completely through the endoscope, curing the pre-cancerous change in a single session without any surgical incision.
Why Early Endoscopic Detection and EMR Mattered
01 — Catching What Scans Cannot See
CT and PET scans only reveal masses. Advanced endoscopic imaging detects flat, pre-cancerous change at its earliest, most curable stage.
02 — Cure Before Cancer Forms
Removing high-grade dysplasia eliminates the lesion before it can ever become invasive cancer — true prevention, not just treatment.
03 — No Surgical Incision
The abnormal lining is removed entirely through the endoscope. No chest or abdominal surgery, no removal of the oesophagus.
04 — Faster Recovery
Days of recovery instead of months. Most patients return to normal activity within a week, compared to a long, difficult recovery after oesophagectomy.
How the Procedure Was Performed
- High-definition endoscopy — the oesophagus was re-examined under high-definition white light to relocate the Barrett’s segment and suspicious area.
- NBI mapping — narrow band imaging was used to precisely delineate the margins of the dysplastic lesion for complete removal.
- Submucosal lift — a solution was injected beneath the lesion to lift the abnormal mucosa away from the deeper oesophageal wall, ensuring a safe resection plane.
- Mucosal resection — the lifted dysplastic segment was captured and resected en bloc using a band-ligation EMR technique.
- Specimen retrieval — the resected tissue was retrieved intact and sent for detailed histopathology to confirm clear margins.
- Site inspection — the resection bed was inspected and confirmed clean, with no bleeding and no residual abnormal tissue.
Procedure Summary
Procedure | Endoscopic Mucosal Resection (EMR) of dysplastic Barrett’s segment |
Imaging Used | High-definition endoscopy with NBI; EUS for staging |
Duration | 60 minutes |
Sedation | Conscious sedation with anaesthesia support |
Hospital Stay | Day-care / overnight, discharged the following morning |
Doctor’s Quote
“Scans are excellent at finding lumps, but a pre-cancerous change in the oesophageal lining is flat and microscopic — it simply does not show up on a CT or PET scan. With high-definition endoscopy and narrow band imaging, we could see what the scans missed entirely. We removed the abnormal lining through the endoscope and, in doing so, prevented a cancer before it ever formed. This is the real power of advanced diagnostic endoscopy — catching disease at the one stage where it is completely curable.”
Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Soft diet for several days, advancing gradually as the resection site heals
Strict acid suppression (high-dose proton pump inhibitor) to protect the healing lining and control reflux
Avoid alcohol, smoking, and very hot or spicy foods during recovery
Surveillance endoscopy with NBI at scheduled intervals to confirm no recurrence of dysplasia
Ongoing follow-up with Dr. Vipulroy Rathod for reflux control and Barrett’s surveillance
Outcome
| Timepoint | Result |
|---|---|
| Within 24 hrs | Comfortable, tolerating liquids, discharged with no complications |
| Histopathology | Confirmed high-grade dysplasia fully removed with clear margins; no invasive cancer |
| 1 Week | Returned to normal activity, eating soft diet comfortably |
| 1 Month | Resection site healed well, reflux well controlled on medication |
| 3 Months | Surveillance endoscopy with NBI showed no residual or recurrent dysplasia |
| 12 Months | Remained dysplasia-free; ongoing routine Barrett’s surveillance |
Long-Term Expectations
With the pre-cancerous lesion completely removed before it could progress, Mr. Deshmukh’s risk of developing oesophageal cancer has been dramatically reduced. He will continue regular surveillance endoscopy with narrow band imaging to detect and treat any new areas of Barrett’s change early. Strict reflux control, lifestyle modification, and adherence to his surveillance schedule will remain central to his long-term oesophageal health.
Patient Feedback
“My scans were normal and I was told there was nothing to worry about. Something still felt wrong, so I went to Dr. Rathod for one more opinion. His endoscopy found a problem the scans had completely missed — and he removed it before it could turn into cancer. He may well have saved my life. I cannot thank him enough.”
Prakash Deshmukh, 58 | Aurangabad, Maharashtra“We had almost stopped worrying because every report said normal. Dr. Rathod took the time to look deeper and explained everything so clearly. Catching it this early changed everything for our family. We are forever grateful for his thoroughness.”
Mrs. Meena Deshmukh, Patient’s Wife | Aurangabad, Maharashtra
