title: Does hyaluronic acid stimulate tumor growth after endoscopic mucosal resection?
abstract: OBJECTIVE
  A submucosal injection of sodium hyaluronate is widely used for mucosal elevation in endoscopic mucosal resection (EMR) or endoscopic submucosal dissection procedures; however, the oncologic safety of sodium hyaluronate remains unknown. Hyaluronate is the main ligand for CD44 and this interaction was reported to promote tumor progression in in vitro or animal studies. This study aimed to evaluate the effects of sodium hyaluronate on tumor growth after EMR for gastrointestinal cancers.
  
  
  METHODS
  The study included 18 consecutive patients who underwent surgery for locally-recurrent or remnant gastrointestinal cancers after EMR from January 2001 to December 2006. The immunohistochemical expression levels of Ki-67, CD44, ErbB2, and epidermal growth factor receptor (EGFR) were evaluated in the primary tumor tissue and the recurrent tumor. The protein expression in recurrent or remnant lesions was also compared between the sodium hyaluronate group and non-sodium hyaluronate group.
  
  
  RESULTS
  Sodium hyaluronate was used in nine of 14 cases with EMR for gastric cancers and in one of four cases for colon cancers. The time to operation after EMR was 133 days (5-687 days). An analysis of the immunohistochemical expression levels between primary and recurrent or remnant tumors showed no significant differences in the expression levels of Ki-67, CD44, ErbB2, and EGFR with or without sodium hyaluronate.
  
  
  CONCLUSIONS
  We found no evidence that sodium hyaluronate stimulates the growth of remnant tumors after EMR.
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Dae Kyung
authors.initials: DK
authors.lastname: Sohn
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Chang
authors.forename: Hyo Seong
authors.initials: HS
authors.lastname: Choi
authors.forename: Seung-Yong
authors.initials: SY
authors.lastname: Jeong
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid