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Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study.

  • 2020-06-08
  • Journal of gastroenterology and hepatology 35(11)
    • Yusuf Coskun
    • Ilhami Yuksel

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 237
Population
474 outpatients
Methods
prospective, randomized, and endoscopist-blinded study, 474 outpatients randomly assigned to two groups: Group 1 receiving split high-dose (1000 mg) sennoside solutions, and group 2 receiving 4 L of PEG
Blinding
Single-blind
  • Large Human Trial

Background and aim

The aim of this study was to compare the quality and tolerability of bowel preparation using split high-doses of sennosides versus split-dose polyethylene glycol (PEG).

Methods

In this prospective, randomized, and endoscopist-blinded study, 474 outpatients were included and randomly assigned to two groups: Group 1 was comprised of 237 patients receiving split high-dose (1000 mg) sennoside solutions, and group 2 included 237 patients receiving 4 L of PEG. The efficacy of the preparations was evaluated on the Boston Bowel Preparation Scale (BBPS), and compliance and adverse effects were recorded.

Results

The quality of colon cleansing and the ease of bowel preparation were significantly better in the senna group; the mean of total BBPS scores was 7.35 in the senna group and 6.57 in the PEG group, cleansing was adequate (BBPS score ≥ 6) in 89.9% of patients taking senna, and 73.8% in the PEG group (P = 0.001). The rates of vomiting in the senna and PEG groups were 12.7% and 29.5%, nausea rates were 28.7% and 43.9%, and abdominal pain rates were 70.9% and 43%, respectively (P < 0.001). Cecal intubation rates in the senna and PEG groups were 95.4% and 86.1% (P = 0.001), and the cecal intubation times were 6.73 ± 2.84 and 5.34 ± 5.98 min, respectively (P = 0.001).

Conclusions

Split high-dose senna is more effective than split-dose PEG in terms of bowel preparation quality and patient compliance. The patients who received senna had significantly less vomiting and nausea but significantly more abdominal pain. Thus, senna may be used as an alternative to PEG for bowel preparation.

Research Insights

  • Senna→Improved Bowel Cleansing Quality

    The quality of colon cleansing and the ease of bowel preparation were significantly better in the senna group; the mean of total BBPS scores was 7.35 in the senna group and 6.57 in the PEG group, cleansing was adequate (BBPS score ≥ 6) in 89.9% of patients taking senna, and 73.8% in the PEG group (P = 0.001).

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    1000 mg split high-dose
  • Senna→Improved Cecal Intubation Rate

    Cecal intubation rates in the senna and PEG groups were 95.4% and 86.1% (P = 0.001)

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    1000 mg split high-dose
  • Senna→Reduced Cecal Intubation Time

    the cecal intubation times were 6.73 ± 2.84 and 5.34 ± 5.98 min, respectively (P = 0.001)

    Effect
    Beneficial
    Effect size
    Small
    Dose
    1000 mg split high-dose

Adverse Events Reported

  • Senna→abdominal pain

    abdominal pain rates were 70.9% and 43%, respectively

    Finding
    Increased risk
    Magnitude
    70.9% vs 43%
    Significant
    Yes
  • Senna→nausea

    nausea rates were 28.7% and 43.9%

    Finding
    Increased risk
    Magnitude
    28.7% vs 43.9%
    Significant
    Yes
  • Senna→vomiting

    The rates of vomiting in the senna and PEG groups were 12.7% and 29.5%

    Finding
    Increased risk
    Magnitude
    12.7% vs 29.5%
    Significant
    Yes
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