Patient Profile
Patient Name
Mr. Joseph Ngolong
Consultant
Dr. Vipulroy Rathod
Diagnosis
Early Stage Colon Cancer Missed on a Prior Standard Colonoscopy
Age / Gender
60 Years / Male
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Ongoing digestive complaints, previously evaluated at overseas centres with a colonoscopy and upper endoscopy reported as normal
Patient Background
Mr. Joseph Ngolong, a 60 year old gentleman, travelled from overseas to seek further opinion for persistent digestive complaints after visiting a couple of centres abroad without lasting relief. He carried a report from an endoscopy and colonoscopy performed just a month earlier, which had described the esophagus, stomach, small intestine and large intestine as entirely normal. He consulted Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Hospital, Mulund, Mumbai, and a specialist in high resolution and narrow band imaging endoscopy. On listening to his complaints, Dr. Rathod felt the findings did not fully explain his symptoms and recommended that the endoscopic evaluation be repeated with advanced imaging technique, despite the recent normal report. Mr. Ngolong agreed, though reluctantly, given he had already undergone a procedure so recently.
Symptoms
Persistent digestive complaints that had not settled despite a recent normal endoscopy and colonoscopy abroad
Symptoms significant enough to prompt evaluation at multiple centres overseas before arriving in India
No obvious abnormality on standard endoscopic assessment, despite ongoing symptoms
Diagnostic Method
Review of prior overseas report
showed a colonoscopy and upper endoscopy from one month earlier reported as normal across the esophagus, stomach, small intestine and large intestine
Clinical assessment
raised suspicion that the reported findings did not fully account for the patient's ongoing digestive symptoms, prompting a recommendation to repeat the endoscopic evaluation
High definition, high resolution colonoscopy with narrow band imaging and magnification
was performed and identified a subtle, very early cancerous change within the large intestine that had not been visible on the earlier standard examination
Endoscopic assessment of the lesion
confirmed the lesion was superficial and confined to the inner lining, making it suitable for complete removal through the endoscope rather than surgery
Disease Diagnosed
Mr. Ngolong was found to have a very early stage cancerous change within a lesion in the large intestine, a finding that had been missed on a standard colonoscopy performed only a month earlier. Such subtle, early lesions can be extremely difficult to identify without high definition, high resolution imaging combined with narrow band and magnification techniques. Left undetected, this finding was assessed as likely to progress to a fully developed cancer within a matter of months to about a year. Because it was caught at such an early stage, Dr. Rathod determined that it could be completely removed endoscopically, without the need for surgery.
Risks if Left Undetected:
Progression from an early, superficial cancerous change to a fully invasive colon cancer over the following months
Continued unexplained digestive symptoms with the true cause remaining undiagnosed
A significantly more complex treatment pathway, likely involving surgery, had the lesion been found only after further progression
Treatment Plan
Dr. Vipulroy Rathod performed Endoscopic Mucosal Resection (EMR) to remove the early cancerous lesion from the large intestine, entirely through the colonoscope and without any surgical incision.
Why Repeat Endoscopy and EMR Were Chosen
01 — Advanced Imaging Uncovers What Standard Endoscopy Can Miss
High definition, high resolution colonoscopy with narrow band imaging and magnification can reveal subtle, flat, early lesions that are easily overlooked on a standard examination.
02 — Early Detection Allows Endoscopic Cure
Because the lesion was caught at a very early stage and confined to the inner lining, it could be removed completely through the endoscope, avoiding the need for a surgical bowel resection.
03 — No Abdominal Incision
The entire resection was carried out through the colonoscope, with no abdominal cuts, no external scars and no surgical wound to heal.
04 — Definitive Treatment in a Single Sitting
The lesion was fully removed in the same procedure used to detect it, addressing the underlying cause found on repeat evaluation.
How the Procedure Was Performed
- High definition colonoscopy: a detailed examination of the large intestine was carried out using narrow band imaging and magnification to precisely characterise the lesion
- Submucosal lift: a fluid cushion was injected beneath the lesion to lift it away from the deeper layer of the bowel wall
- Snare resection: the lifted lesion was captured with a wire snare and removed using controlled electrocautery
- Margin inspection: the resection site was examined closely to confirm complete removal with no residual abnormal tissue at the edges
- Site closure: the resection site was checked and secured to reduce the risk of delayed bleeding
Procedure Summary
| Procedure | High definition narrow band imaging colonoscopy with Endoscopic Mucosal Resection (EMR) |
| Approach | Entirely transanal through the colonoscope, no external incision |
| Duration | 50 minutes |
| Sedation | Conscious sedation with continuous monitoring |
| Hospital Stay | Same day discharge after a period of observation |
Doctor’s Quote
“He showed me a report done just a month earlier, and it described his esophagus, stomach, small intestine and large intestine as entirely normal. Somehow, given his complaints, I was not convinced, and I recommended repeating the evaluation. He agreed, though reluctantly. On repeating his colonoscopy with high resolution, high definition, narrow band and magnification imaging, we found a very early stage cancerous change forming in the colon, one that would have been missed on a standard examination. We removed it endoscopically using EMR in the same sitting. Had we not repeated this colonoscopy, he may well have returned with a full blown cancer within six months to a year. Eyes do not see what the mind does not know, and experience has no alternative in any professional field.”
Dr. Vipulroy Rathod, Director of Gastroenterology, Fortis Hospital, Mulund, Mumbai
Post-Procedure Guidelines
Clear liquids for a few hours after the procedure, advancing to a light and then normal diet over the next day
Avoid heavy lifting and strenuous activity for about a week to lower the risk of delayed bleeding
Watch for and promptly report abdominal pain, fever, or blood in the stool
Share the endoscopic and histopathology findings with the referring physician for continuity of care
Follow up surveillance colonoscopy at the interval advised by Dr. Rathod to confirm complete healing and rule out recurrence
Outcome
| Timepoint | Result |
| Same Day | Uneventful recovery from sedation, no immediate bleeding, discharged with routine advice |
| 1 Week | No abdominal pain or bleeding, back to normal daily activities |
| 1 Month | Digestive symptoms notably improved, resection site healing well |
| 3 Months | Follow up review confirmed a well healed resection site with no residual or recurrent lesion |
Long-Term Expectations
With the early cancerous lesion completely removed at such an early stage, Mr. Ngolong’s outlook is excellent, and a treatment pathway that could otherwise have required surgery and cancer directed therapy was avoided altogether. Periodic surveillance colonoscopy will remain part of his ongoing care to monitor for any new growths, along with attention to any recurring digestive symptoms. His case underscores the value of advanced imaging and a thorough clinical assessment even when a recent report appears reassuring.
Patient Feedback
“I had already been through an endoscopy and colonoscopy just a month before, and I was told everything was normal, so I did not see the need to go through it again. Dr. Rathod listened carefully to my symptoms and felt strongly that we should repeat the evaluation. I am glad I agreed, because a serious problem was found and treated early, entirely through the scope, with no operation needed. I am grateful this was caught in time.”
Joseph Ngolong, 60
