AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Osborne Vaz, Hepatopancreaticobiliary Unit, Department of General Surgery , Royal Blackburn Hospital, East Lancashire NHS Hospital Trust, Blackburn, Lancashire, UK. BB2 3HH.
Citation: Vaz O., Shofiq Al – Islam,Khan Z. ,Neil Wilde , Lowe B.Magilton A Subar D., (2022) Bio-Degradable Stents: Primary Experience in a Tertiary HPB Centre in the United Kingdom. J. Gastroenterology Pancreatology and Hepatobilary Disorders 6(1) DOI:10.31579/2641-5194/038
Copyright: © 2022, Osborne Vaz, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 28 June 2021 | Accepted: 17 November 2021 | Published: 04 January 2022
Keywords: benign biliary strictures, biodegradable stents, percutaneous transhepatic cholangiography
Background: Management of benign biliary strictures (BBS) post bilioenteric anastomoses requires a multidisciplinary approach including surgical, radiological and/or endoscopic input. Patients often need multiple hospital visits for treatment with the long term possibility of restenosis. Conventionally BBS have been treated with serial percutaneous transhepatic biliary dilatations necessitating repeat procedures for drain exchange or removal Surgery may become necessary in refractory strictures. In the last decade there has been increasing reports of the use of biodegradable stents (BDS) in treating biliary strictures mainly to address the need for repeated procedures for drain exchange.
Aims: This study aimed to report the early outcomes in patients with benign biliary strictures treated with biodegradable stents.
Methods: Retrospective analysis of prospectively collected data was performed of patients who had a bilioenteric anastomosis presenting with an anastomotic stricture and were intended to be treated with BDS. The primary end points reported on were technical success (defined as successful resolution of stricture on repeat cholangiogram) and clinical success (defined as absence of repeated cholangitis). Clavien– Dindo grade of complication were reported.
Results: Twelve patients presented with BBS and nine patients had BDS. Three patients were not considered suitable for BDS stenting due to a non-traversable stricture and had surgery. The male female ratio was 1:2. There was 100% technical and clinical success with one patient having stent migration not needing intervention. The procedure took an average of 45 minutes. In seven (77.7%) patients, it was safely performed under local anaesthesia with sedation. Two patients preferred general anaesthesia. There was no restenosis noted at a median follow up of 11 months.
Conclusion: The use of BDS in the treatment of BBS is a safe and effective procedure. Longer term follow-up with multi-institutional reporting on a national database is needed to assess its long term benefits.
CBD: Common Bile Duct.
BBS: Benign biliary stricture
BDS: Biodegradable stent.
ERCP: Endoscopic Retrograde Cholangiopancreatography.
HJ: Hepaticojejunostomy
LC: Laparoscopic cholecystectomy
PTBD: Percutaneous transhepatic biliary dilatation.
PTC: Percutaneous transhepatic cholangiography.
Benign biliary strictures (BBS) post bilioenteric anastomosis are seen in 2.6% - 17% of patients [1]. Those due to injuries post laparoscopic cholecystectomy (LC) are seen in 0.3% to 0.7% of patients [2,3]. Management requires a multidisciplinary approach including cross abdominal imaging including magnetic resonance cholangiopancreaticography (MRCP) and or computerised tomography (CT). These help delineate the anatomy with respect to location, number of strictures, length and associated anatomical anomalies including vascular injuries. While there is no standard accepted classification for BBS, the application of the Bismuth classification in BBS may assist in clinical treatment decision making [3].
Historically surgery was the only option but since the 1970s non operative management is generally now considered the first treatment of choice [4 - 6]. It is less invasive, has lesser morbidity and shorter hospital stay when compared to surgery [6]. The success rates are comparable to surgery [6].However there is no gold standard in treatment of BBS.
In patients with no prior bilioenteric anastomosis endoscopic retrograde cholangiopancreatography (ERCP) conventionally remains the first intervention of choice 3. However, in those with an altered anatomy due to bilioenteric anastomosis or an endoscopically non traversable stricture, percutaneous transhepatic cholangiography with biliary decompression (PTBD) is the first intervention of choice [4,7]. PTBD has been reported to be less invasive and pose lesser risk than surgery [2, 8]. However, classically PTBD needs repeated procedures to sequentially upsize the drains and serially dilate the stricture which has led to the increasing interest in the use of biodegradable stents (BDS). Placement of BDS has many advantages over PTBD as it removes the need for repeated procedures, improves quality of life as the patient has no external drainage catheter to manage and reduces the risk of complications associated with external drainage [9].
The aim of this study was to report the early outcomes in patients with benign biliary strictures treated with biodegradable stents.
This is an observational study with retrospective analysis of prospectively collected data at a tertiary HPB centre in the United Kingdom.
All patients who had a request for radiological treatment of a biliary stricture with BDS between January 2017 to June 2020 were recorded on a database. These patients were considered potentially suitable for BDS after a multidisciplinary team discussion. Patient details were acquired from the records of the radiology and surgical departments of the hospital. The details of the procedure were accessed from the procedure notes kept in the patient records and the electronic patient record (EPR) system. Details on follow up were accessed via the EPR and outpatient clinic notes.
The stent used was a polydioxanone stent and all were custom made and procured from SX-ELLA ®, S.R.O, Hradec Kralove Czech Republic. All stent insertions were done by qualified interventional radiologists.
The protocol followed for the patients with biliary stricture was cross sectional abdominal imaging, followed by a per cutaneous transhepatic cholangiogram with biliary decompression (Fig 1 demonstrating a stricture seen on MRCP). The patient then underwent serial dilatations with up- sizing of the external drain to 16Fr. If the stricture persisted, they were considered for insertion of a BDS. The dilated stricture was mapped for dimensions and a custom-made stent procured from the aforementioned company. The procedure was performed by two interventional radiologists. Post BDS placement, a check cholangiogram was carried out after 7 days. (Figure 2 cholangiogram post stent placement) The external biliary drain was removed if the cholangiogram was satisfactory and the stent tract filled with Avitene ® for haemostasis and reduce the chances for bile leak.
Descriptive statistical analysis was done for all patients. Variables included age, gender, and primary surgical procedure, number of PTBDs, attempts at BDS placement, technical and clinical success, complications and follow up. The complications included but not limited to bleeding, bile leak, drain displacement, cholangitis, drain obstruction, vascular injury, biliary peritonitis, injury to intra-bdominal viscera and pleural complications. The Clavien Dindo (CD) classification was used to categorise grade of complication.
There were twelve patients identified with benign biliary strictures, eleven of whom had bilioenteric anastomosis. One patient had a common hepatic duct stricture post laparoscopic cholecystectomy.
Three patients did not qualify for a BDS. In these three patients the bilioenteric stricture was refractory to PTBD and the stricture could not be traversed radiologically. All three patients had a bile duct injury post laparoscopic cholecystectomy, two of whom had undergone a hepaticojejunostomy and has a HJ stricture. All 3 underwent successful redo hepaticojejunostomies with no post-operative complications to date (Table B).
Nine patients had BDS with a male female ratio of 1:2. The median age was 65 years [range 32 – 77 years]. All nine (100%) had undergone a hepaticojejunostomy in the past which had stenosed. Three (33.3%) had a Whipple’s procedure for pancreatic malignancies, one (11.1%) had a reconstruction after right hepatectomy for colorectal liver metastases with Roux en Y reconstruction. The bile duct was not involved with malignancy in any of these patients and there was no evidence of disease recurrence at the time of BDS insertion. Four (44.4%) patients had a CBD injury post laparoscopic cholecystectomy and one (11.1%) had bilio enteric reconstruction post-surgery for Mirizzi’s syndrome (Table B).
The average time to development of anastomotic stenosis was 28.1 months from primary repair [range 4-160]
The median number of dilatations needed prior to insertion of the BDS
were three (range 2-6). The median time taken in weeks for stent procurement and insertion from last PTBD was 11 weeks [range 6.5 – 25.5]
Seven (77.7%) of the stent placements were carried out as day case procedures and two (22.2%) had a 24 hour stay. Local anaesthesia and sedation were used in seven (77.7%) of the patients whilst two (22.2%) needed general anaesthesia. the procedure took an average of 45 minutes. Technical and clinical success was 100% .All patients needed only one BDS placement.
One patient had a stent migration that did not require any intervention (CD1). The median follow-up was 11 months [range 4 – 39 months]. No patients required further intervention and no cholangitis and restenosis were noted at follow up (Table C).
The incidence of benign biliary strictures post bilioenteric reconstruction have been reported in the literature to be between 2.6% - 17% % 1,4 and those post laparoscopic cholecystectomy between 0.3 %– 0.7% 3.
Whilst PTBD with serial dilatations with or without stenting has been the mainstay in BBS post bilioenteric anastomosis [1,5,8,10-12] , there has been an emergence in the use of biodegradable stenting in the past decade [7,9,13-16]
The use of biodegradable stents was first described in interventional cardiology and thereafter in oesophageal and urethral strictures. Recently, there have been increasing reports of its use in the treatment for biliary strictures. This is mainly to address the need for reinterventions to exchange or remove stents and refractory stenosis. [3, 17, 18]
The first published case report of usage of a biliary BDS was via ERCP and demonstrated technical and clinical success [19]. Thereafter these stents have been used for endoscopic treatment of biliary strictures usually post cholecystectomy biliary injuries 3, 17 before gaining usage via the percutaneous methods [9, 13].
Manufacturer studies [7] suggest that the radial strength of the stent is maintained for the first five weeks which gradually recedes to two thirds the initial value at week seven post insertion and one thirds at week nine. The degradation products are not harmful to human tissues. Studies have shown that BDS express proteins which tend to be similar to those observed in intact bile ducts [19-21].
Our study reflects similar outcomes to what is published in the literature to date. The largest study by de Gregorio et al [9] suggests that a stent patency of 78.9% is observed at 60 months. Of those with restenosis, 12% patients needed a second stent and 14.6% needed definitive operative repair. None of their patients had major complications due to stent placements. Another study by Mauri et al [13] also demonstrated similar outcomes with stricture recurrence in 18% of patients with estimated time to re-stricture of 38 months [13].
To the best of our knowledge, this is the largest series in the United Kingdom reported to date.Our study included a small cohort and a short follow up period. The efficiency of the procedure is limited by the unavailability of a local manufacturing source and the fact that stents are made to order. The stents are off label and need a special prescription. The process of stent acquisition and insertion took a median of 11 weeks. There is also special permission needed for cost reimbursement which prolongs treatment time.
The cost of metal stenting is £2900 and each PTC episode pre- and post-stenting costs £890. Bilioenteric bypass surgery costs £13606. Comparitively the average cost of PTBDs followed by BDS insertion in the patients from this study amounted to £7837. BDS is evidently more cost effective than surgery. The cost of multiple plastic stenting and metal stentings increases with each additional procedure. Complications due to repetitive procedures also add to the financial burden in fully covered self-expanding metal stenting and multiple plastic stenting.
Biodegradable stent insertion via percutaneous transhepatic route can safely be performed as a day case procedure, is cost effective and has high success rates. The post procedural complication rates are minimal. These factors contribute immensely to improving patient outcomes and reducing hospital costs. Larger multicentre trials are needed and a consensus needs to be arrived at for standardisation of the selection criteria in what is a small number of patients presenting at any single HPB unit.
The authors of this original paper declare no conflicts of interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
