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Patient Profile
Patient Name
Mr. Anil Kulkarni
Consultant
Dr. Vipulroy Dayanand Rathod
Diagnosis
Early-Stage Gastric Cancer (Mucosa-Confined Adenocarcinoma)
Age / Gender
64 Years / Male
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Chronic gastritis · H. pylori infection (treated) · Family history of stomach cancer
Patient Background
Mr. Anil Kulkarni, a 64-year-old retired bank officer from Kolhapur, Maharashtra, had a history of chronic gastritis and a treated H. pylori infection. With a family history of stomach cancer, he underwent a screening upper endoscopy that revealed a small, flat, suspicious lesion in the stomach lining. A biopsy confirmed early gastric cancer confined to the mucosa. At another centre he was advised partial gastrectomy surgical removal of part of the stomach. Hoping to avoid major surgery, his family searched for the Best Gastroenterologist In Mumbai experienced in advanced therapeutic endoscopy. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of Endoscopic Ultrasound with over 20,000 EUS procedures, recommended Endoscopic Submucosal Dissection (ESD) to remove the cancer in one piece through the endoscope, preserving the entire stomach.
Symptoms
Persistent indigestion — long-standing dyspepsia and a vague fullness after meals
Mild upper abdominal discomfort — intermittent, not relieved fully by antacids
Occasional nausea — especially after heavy or spicy food
Mild loss of appetite — with marginal, unintentional weight loss
No alarming symptoms — no bleeding, no vomiting, no severe pain; the lesion was found on screening
Diagnostic Method
High-definition upper endoscopy
detailed inspection of the stomach lining identifying a small, flat, depressed lesion
NBI (Narrow Band Imaging) endoscopy
advanced light filtering delineated the lesion margins and confirmed surface and vascular patterns typical of early cancer
Endoscopic Ultrasound (EUS)
confirmed the tumour was confined to the mucosal layer with no deeper invasion and no suspicious lymph nodes
Targeted biopsies
histopathology confirmed well-differentiated adenocarcinoma, an ideal candidate for endoscopic resection
CT abdomen
no evidence of distant spread, confirming early-stage, localised disease
Disease Diagnosed
Mr. Kulkarni was diagnosed with early-stage gastric (stomach) cancer — a well-differentiated adenocarcinoma confined to the mucosal lining with no deeper invasion or lymph node involvement. Lesions caught at this stage meet the criteria for curative endoscopic resection, avoiding the need to remove part of the stomach. As a gastroenterology specialist for early gastrointestinal cancer, Dr. Rathod identified Endoscopic Submucosal Dissection (ESD) as the technique capable of removing the lesion in a single intact piece for complete cure and accurate staging.
Risks if Left Untreated:
Progression from early, curable cancer to invasive, deeper stomach cancer
Spread to lymph nodes and distant organs, requiring chemotherapy
Need for major gastrectomy with permanent change to digestion and nutrition
Significantly reduced survival once the cancer advances beyond the mucosa
Treatment Plan
Dr. Vipulroy Rathod performed Endoscopic Submucosal Dissection (ESD), dissecting beneath the cancer to remove it as one complete piece through the endoscope, curing the early-stage stomach cancer while keeping the stomach fully intact.
Why ESD Was Chosen Over Surgery
01 — One-Piece (En Bloc) Removal
ESD removes even larger early cancers in a single intact specimen, allowing complete cure and precise pathological staging that piecemeal techniques cannot match.
02 — Stomach Fully Preserved
The entire stomach is kept intact. No gastrectomy, no rerouting of the digestive tract, and no permanent change to how the patient eats.
03 — No Surgical Incision
The cancer is removed entirely through the endoscope. No abdominal opening, no surgical wound, and a far lower complication risk.
04 — Faster Recovery
Days of recovery instead of weeks. Most patients return to normal activity within a week, compared to a long recovery after open or laparoscopic gastrectomy.
How the Procedure Was Performed
- High-definition endoscopy — the stomach was re-examined under high-definition white light to relocate the lesion and assess its position.
- NBI margin marking — narrow band imaging defined the precise edges of the cancer, and marking dots were placed a safe distance around the lesion.
- Submucosal injection — a lifting solution was injected beneath the lesion to raise it away from the deeper stomach wall, creating a safe dissection cushion.
- Mucosal incision — a circumferential incision was made through the mucosa around the marked margins using an electrosurgical knife.
- Submucosal dissection — the lesion was carefully dissected free along the submucosal plane, keeping it in one continuous piece.
- En bloc retrieval — the entire lesion was removed intact and retrieved for detailed histopathology to confirm clear deep and lateral margins.
- Defect inspection — the resection bed was inspected, and any visible vessels were treated to prevent delayed bleeding.
Procedure Summary
| Procedure | Endoscopic Submucosal Dissection (ESD) — en bloc resection of early gastric cancer |
| Imaging Used | High-definition endoscopy with NBI; EUS for staging |
| Duration | 120 minutes |
| Sedation | General anaesthesia / deep sedation with anaesthesia support |
| Hospital Stay | Two nights, discharged after confirming no bleeding |
Doctor’s Quote
“When stomach cancer is caught early, while it is still confined to the lining, we have a remarkable opportunity. With Endoscopic Submucosal Dissection we can remove the entire cancer in one intact piece through the endoscope, without removing any part of the stomach. Mr. Kulkarni was cured of his cancer and kept his whole stomach, eating normally within days. For early gastric cancer, this is the difference between a major operation and a complete cure with the organ preserved.”
Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Clear liquids initially, advancing to soft and then normal diet over one to two weeks as the resection site heals
Strict acid suppression (high-dose proton pump inhibitor) to protect the resection ulcer while it heals
Avoid alcohol, smoking, and very hot or spicy foods during recovery
Watch for and promptly report black stools, vomiting blood, or severe abdominal pain
Surveillance endoscopy at scheduled intervals to confirm complete healing and no recurrence
Ongoing follow-up with Dr. Vipulroy Rathod for H. pylori status and long-term gastric surveillance
Outcome
| Timepoint | Result |
|---|---|
| Within 24 hrs | Stable and comfortable, no bleeding, tolerating liquids |
| Day 2 | Discharged from hospital on soft diet and acid suppression |
| Histopathology | Confirmed early cancer removed en bloc with clear deep and lateral margins — curative resection |
| 1 Week | Returned to normal activity, eating soft diet comfortably |
| 1 Month | Resection site healing well, eating normally, no symptoms |
| 3 Months | Surveillance endoscopy confirmed a healed scar with no residual or recurrent cancer |
| 12 Months | Remained cancer-free with a fully preserved stomach; routine surveillance ongoing |
Long-Term Expectations
With the early cancer removed completely in one piece and margins confirmed clear, Mr. Kulkarni’s stomach cancer has been cured while his stomach remains fully intact. He will continue regular surveillance endoscopy to detect any new lesions early, given his family history and prior gastritis. Maintaining H. pylori eradication, avoiding tobacco and excess alcohol, and adhering to his surveillance schedule will remain central to his long-term gastric health.
Patient Feedback
“I was told I had cancer and that part of my stomach would have to be removed. I was terrified. Dr. Rathod offered me a different path — he removed the cancer through a scope in one piece and saved my whole stomach. Within a week I was eating again and the reports said I was cured. I owe him more than I can ever express.”
Anil Kulkarni, 64 | Kolhapur, Maharashtra“The word cancer frightened our entire family. Dr. Rathod explained everything calmly and gave us real hope. My father kept his stomach and his health, and he is back to his normal routine. We are deeply grateful for his skill and kindness.”
Mr. Sachin Kulkarni, Patient’s Son | Kolhapur, Maharashtra
