The Efficacy of Senna Bowel Preparation for Colonoscopy: A Systematic Review and Meta-analysis.

2022-06-25
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 45(6)
- Hefeng Tian
- Ying Fan
- Lei Yang
- Sai Hou
- Wen Huang
- Ruizhi Dong
- Shaodong Li
- Xuanrui Zhu
- Wenlong Liu
- Guanghuan Shi
- Xiaoke Li
- Shiping Zhou
- Xiu Wang

PubMed: 35758925
DOI: 10.1097/sga.0000000000000664

Study Design

Type: Meta-Analysis
Sample size: n = 343
Population: 3,343 patients from 11 trials
Methods: systematic review and meta-analysis; searched Web of Science Core Collection, MEDLINE, PubMed, Embase, Cochrane Library, and Scopus databases from inception to August 2021

The quality of bowel preparation is an extremely important determinant of colonoscopy results. However, the efficacy of senna regimens in improving bowel cleanliness is uncertain. We conducted a systematic review and meta-analysis to synthesize data on whether using a senna bowel preparation regimen enhances the bowel cleanliness. We searched Web of Science Core Collection, MEDLINE, PubMed, Embase, Cochrane Library, and Scopus databases (from the inception to August 2021). The primary efficacy outcome was bowel cleanliness. Secondary outcomes included patient compliance, tolerance, and adverse events. Eleven trials fulfilled the inclusion criteria (3,343 patients. Overall, we found no significant differences in bowel cleanliness between the senna regimen and other bowel preparation regimens (odds ratio [0.63, 1.67], p = 0.93). There was significant difference in tolerance (odds ratio [1.08, 2.54], p = .02) and compliance (odds ratio [1.42, 6.55], p = .004). The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [1.45, 2.32]) and vomiting (odds ratio [0.81, 3.35]). Compared with other bowel preparation regimens, the senna regimen may be effective and safe in bowel cleaning before colonoscopy, with superior compliance and tolerance.

Research Insights

Senna→Improved Bowel Cleanliness
Overall, we found no significant differences in bowel cleanliness between the senna regimen and other bowel preparation regimens (odds ratio [95% confidence interval]: 1.02 [0.63, 1.67], p = 0.93).
Effect
Neutral
Effect size
Small
Senna→Improved Compliance
There was significant difference in tolerance (odds ratio [95% confidence interval]: 1.66 [1.08, 2.54], p = .02) and compliance (odds ratio [95% confidence interval]: 3.05 [1.42, 6.55], p = .004).
Effect
Beneficial
Effect size
Large
Senna→Reduced Nausea
The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [95% confidence interval]: 1.84 [1.45, 2.32])
Effect
Beneficial
Effect size
Moderate

Adverse Events Reported

Senna→nausea
The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [95% confidence interval]: 1.84 [1.45, 2.32]) and vomiting (odds ratio [95% confidence interval]: 1.65 [0.81, 3.35]).
Finding
Increased risk
Magnitude
odds ratio [95% confidence interval]: 1.84 [1.45, 2.32]
Significant
Yes
Senna→vomiting
The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [95% confidence interval]: 1.84 [1.45, 2.32]) and vomiting (odds ratio [95% confidence interval]: 1.65 [0.81, 3.35]).
Finding
Increased risk
Magnitude
odds ratio [95% confidence interval]: 1.65 [0.81, 3.35]
Significant
No
Senna→nausea
The senna regimen yielded a significantly greater proportion of no nausea (odds ratio [95% confidence interval]: 1.84 [1.45, 2.32])
Finding
No significant difference
Magnitude
odds ratio [95% confidence interval]: 1.84 [1.45, 2.32]
Significant
Yes
Senna→vomiting
and vomiting (odds ratio [95% confidence interval]: 1.65 [0.81, 3.35])
Finding
No significant difference
Magnitude
odds ratio [95% confidence interval]: 1.65 [0.81, 3.35]
Significant
No
Senna→Overall tolerability
Compared with other bowel preparation regimens, the senna regimen may be effective and safe in bowel cleaning before colonoscopy, with superior compliance and tolerance.
Finding
Reported