3.2.3 Functional benefits of ETF

• In a systematic review of ETF in hospital patients by Stratton et al. ETF was found to produce functional benefits in 67% of RCTs in patients with COPD, cystic fibrosis, liver disease, cancer and in post-surgery patients. Depending on the patient group these included significant improvements in:⁵⁰
  • respiratory function
  • liver function
  • bowel function
  • wound healing
  • well-being
  • immune function

• The benefits were typically accompanied by substantial improvements in weight (~6% difference between ETF and control patients).⁵⁰
• Another systematic review found that ETF improved health-related quality of life (QoL) in patients with chronic conditions. Ojo et al. 2019⁵⁸ found that ETF provides functional benefits including:
  • Improved nutritional status and better overall health outcomes
  • Enhancements in patients’ social and emotional well-being, as evidenced by their reports of greater comfort and social activity capacity

These benefits were frequently accompanied with enhancements in some areas of functional well-being and overall health status.

• A meta-analysis which assessed 5 RCTs and 3 non-randomized prospective studies (NPSs) all on patients with traumatic brain injury showed that, compared with delayed feeding, early feeding was associated with a significant reduction in the rate of poor functional outcome (RR = 0.70; 95% CI, 0.54–0.91;p <0.05) as assessed by the Glasgow Outcome Scale.⁵⁸ 

• In the systematic review of ETF in the community by Stratton et al. 80% of trials reported improvements in function with ETF. These varied with the patient group and included:⁵⁰
  • improved well-being/quality of life
  • improved pulmonary function
  • reductions in pressure-ulcer surface area

• In an evidence update by the National Institute for Health and Care Excellence in the UK, prophylactic gastrostomy feeding in head and neck cancer patients improved some aspects of quality of life at 6 months (as measured by the European Organization for Research and Treatment of Cancer 30-item Questionnaire): physical functioning (p = 0.02), role functioning (p = 0.05), cognitive functioning (p = 0.008), Global Health Status (p = 0.02), and fatigue (p = 0.01) compared to patients receiving usual care. However, these differences were not significant at 12 or 24 months.⁵⁴ Note: usual care included nutritional advice and enteral feeding when necessary.

• A systematic review assessing the effects of nutritional interventions (including ETF) in patients with cystic fibrosis assessed five studies which described pulmonary function as an outcome measure in CF patients receiving ETF. Two of the five studies showed stabilisation in pulmonary function in the intervention group after 6- and 12-months enteral tube feeding. Two studies demonstrated a gradual decline in pulmonary function after 1 and 2 years of gastrostomy feeding whilst one study found a significant reduction in the rate of pulmonary decline after the start of enteral tube feeding in girls, as well as in adult men (all p <0.05).⁵²
• For CF patients, enteral tube feeding is frequently used when oral intake is insufficient to attain adequate nutritional status. In addition, observational studies indicate that ETF enhances CF patients’ quality of life, respiratory function, and nutritional status. ⁵⁹
• A systematic review of 13 studies looking at the effects of gastrostomy tube placement, on the quality of life of care givers and children with neurological impairment, found no overwhelming conclusions but reported some improvements in perceived quality of life of the child in a thematic analysis.⁵⁶
• In contrast, a Cochrane systematic review on enteral tube feeding in cystic fibrosis found no eligible randomised controlled trials in 2012.⁶⁰ The authors acknowledged that such trials would be very difficult to undertake as ethical approval is unlikely to be granted for a trial withholding an intervention which will probably be of benefit.