Effect of Chinese herbal medicine enema on postoperative gastrointestinal function in gastric cancer patients: A meta-analysis

Abstract

BACKGROUND

Gastric cancer is the fourth most common malignant tumor in the world and China accounts for more than 40% of cases globally. In the postoperative period, gastrointestinal (GI) dysfunction affects 20%-30% of patients and greatly impairs recovery.

AIM

To conduct a meta-analysis of postoperative GI function in patients with gastric cancer treated by Chinese herbal medicine enema.

METHODS

We searched for relevant literature from PubMed, EMBASE, Cochrane Library, CNKI, Wanfang Database, VIP Database and Chinese Biomedical Literature Database from inception to October 2025. The search strategy combined Medical Subject Headings terms and free-text words. English search terms included: (“Chinese herbal medicine” OR “traditional Chinese medicine” OR “herbal enema” OR “retention enema”) AND (“gastric cancer” OR “gastric carcinoma” OR “stomach neoplasm”) AND (“postoperative” OR “post-surgery” OR “after surgery”) AND (“gastrointestinal function” OR “bowel function” OR “intestinal motility”). Inclusion criteria: Randomized controlled trials (RCTs) of the effect of Chinese herbal medicine enema in patients with gastric cancer after radical gastrectomy were selected; observation group received Chinese herbal medicine enema combined with conventional treatment, control group received conventional care; main outcome measures with clearly defined units: Time to first flatus (hours), time to first defecation (hours), time to recover bowel sound (hours, defined as ≥ 3 bowel sounds per minute on auscultation), intestinal flora improvement rate (proportion of patients showing improvement), and postoperative complications categorized by system organ class. RevMan 5.4 software was used for meta-analysis. The I² statistic was used to estimate heterogeneity; when I² ≤ 50% and P ≥ 0.10, fixed-effect models were selected; when I² > 50% or P < 0.10, random-effect models with restricted maximum likelihood estimation and Hartung-Knapp correction were applied, and 95% confidence intervals (95%CI) were calculated for all effect sizes.

RESULTS

A total of 135 records were initially identified through database searches (PubMed: 15, EMBASE: 12, CNKI: 53, Wanfang: 55). After removing 22 duplicates, 113 records were screened by title and abstract. Following initial screening, 101 records were excluded, leaving 12 full-text articles for eligibility assessment. Of these, 6 were excluded (3 for non-RCT design, 2 for intervention not matching inclusion criteria, 1 for incomplete data). Finally, 6 RCTs were included in the meta-analysis, involving 843 patients (434 in observation group, 409 in control group). Meta-analysis results showed: (1) Time to first flatus: Mean difference (MD) = -10.45 hours, 95%CI: -11.48 to -8.82, P < 0.00001, I² = 0%, fixed-effect model; (2) Time to first defecation: MD = -16.80 hours, 95%CI: -19.50 to -14.01, P < 0.00001, I² = 48%, random-effect model; (3) Time to bowel sound recovery: MD = -10.36 hours, 95%CI: -11.35 to -9.37,P < 0.00001, I² = 62%, random-effect model; (4) Intestinal flora improvement rate: Risk ratio = 1.68, 95%CI: 1.45-1.95, P < 0.00001, I² = 66%, random-effect model; and (5) Overall postoperative complications showed no statistically significant difference [odds ratio (OR) = 0.92, 95%CI: 0.69-1.24, P = 0.59, I² = 0%]. Subgroup analysis by complication type: GI complications (OR = 0.88, 95%CI: 0.61-1.28, P = 0.51), enema-related events including rectal irritation and electrolyte imbalance (3 cases in treatment group vs 1 case in control group, OR = 1.82, 95%CI: 0.31-10.64, P = 0.50), anastomotic leak (OR = 0.73, 95%CI: 0.35-1.52, P = 0.40), and infectious complications (OR = 0.95, 95%CI: 0.58-1.56, P = 0.84). Funnel plot analysis showed no obvious publication bias.

CONCLUSION

Chinese herbal medicine enema can effectively promote postoperative GI function recovery in gastric cancer patients, significantly shortening time to first flatus, time to first defecation, and time to bowel sound recovery, improving intestinal flora, without increasing postoperative complications.

Keywords: Gastric cancer; Postoperative complications; Gastrointestinal dysfunction; Chinese herbal medicine enema; Meta-analysis

Core Tip: This meta-analysis systematically evaluated the efficacy of Chinese herbal medicine enema in enhancing postoperative gastrointestinal recovery among gastric cancer patients. Six randomized controlled trials involving 843 patients were analyzed. Chinese herbal medicine enema significantly shortened time to first flatus, defecation, and bowel sound recovery, and improved intestinal flora balance without increasing postoperative complications. These findings highlight that Chinese herbal medicine enema is a safe, effective, and integrative approach to promote gastrointestinal function recovery following gastrectomy.