AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Wadha AlOtaibi. General Surgery Resident, Upper GI Surgery Unit, General Surgery Division, Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Citation: Naif Alsaikhan, Mohammed Alnaami, Fahad Almadi, Wadha AlOtaibi. (2023), Management of a Late and Complex Leak after Sleeve Gastrectomy along with Endoluminal Stent Complications: Lessons Learned, J. Surgical Case Reports and Images, 6(1) DOI: 10.31579/ 2690-1897/130
Copyright: © 2023 Wadha AlOtaibi. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 15 October 2022 | Accepted: 29 October 2022 | Published: 06 January 2023
Keywords: sleeve gastrectomy; leak; stent; complications
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. The most serious complication is gastric leakage. We present a case of morbidly obese patient with multiple comorbidities who was complicated by late gastric leak due to persistent smoking and use of steroids for the treatment of bronchial asthma exacerbations. Due to the large leak size, he was managed initially by external drainage and endoluminal mega stent that was unfortunately complicated by esophageal perforation. Surgical closure of the esophageal perforation was successful to control sepsis from acute mediastinitis; however, it was reopened few days later but controlled externally with the chest tube. A conservative management approach was advised by a multidisciplinary committee conference, which was followed for many months without evidence of leaks closure. Subsequently, the gastric leak and esophageal perforation were successfully managed by the interventional radiology using internal drainage and septal occluder plug for the gastric leak and esophageal perforation respectively.
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Although it has been widely adopted due to its simplicity and excellent weight reduction outcomes, it has a considerable risk of postoperative complications [1]. The most serious complication is gastric leakage, with an overall prevalence of 1%–5% for primary procedures [2,3], which can increase up to 10% for revisionary procedures [4]. Moreover, the incidence of complications increases several folds with the presence of associated risk factors, such as smoking, steroid use, immunosuppressive and biological agents, diabetes mellitus, and obstructive sleep apnea requiring perioperative positive ventilatory support [5,6]. Complications also imply a lengthy hospital stay with higher costs and an increase in morbidity and mortality rates [7,8].
Management of such complications has evolved with the growing experience in bariatric surgery along with other ancillary services. A highly specialized multidisciplinary approach, including experienced bariatric surgery, therapeutic endoscopy and interventional radiology services, adequate resources, and highly specialized bariatric centers are required to deal with difficult bariatric interventions and complications [9,10,11].
We report an unusual case of complex late gastric leak post-LSG complicated by stent esophageal perforation, with the lessons learned from the various disciplines’ management approaches.
A 37-year-old man who was living with severe obesity (BMI = 77.7 kg/m2) associated with backache and bilateral knee osteoarthritis, known asthmatic on regular low-dose prednisolone and salbutamol puffers, and had been a heavy smoker. Due to his severe obesity, the patient was offered single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as a one- or two-stages procedure. The patient preferred the two-stages procedure (i.e. LSG then SADI at a later date). After adequate preoperative preparation and smoking cessation, he underwent an uneventful LSG on July 1, 2020. He was discharged the next day in good condition, visited the clinic once in the early postoperative period, but failed to return afterward. Almost one year later, he presented to another hospital with symptoms and signs of sepsis due to a significant gastric leak (Fig. 1).
Figure 1. Fluorography showing the significant gastric leak with a cavity
As that hospital lacked therapeutic endoscopy and interventional radiology facilities, he underwent exploratory laparoscopy, washout, and drainage. After a good recovery and stabilization, he was transferred to our facility. Initially, he was treated empirically with broad-spectrum antibiotics and antifungals, then placed on parental nutrition (PN). Computed tomography (CT) of the abdomen revealed a small residual collection at the leak site near the gastroesophageal junction (GEJ) that was drained externally under CT guidance using a pigtail catheter. The endoscopic assessment revealed a large hole at the staple line, just below the GEJ (Fig. 2). Given the size of the leak, a long covered endoluminal mega stent was placed. After a few days while on a liquid diet, the patient developed progressive hematemesis refractory to medical treatment. An emergent endoscopic assessment revealed pressure erosions of the esophageal mucosa from the stent.
Figure 2. Endoscopic assessment revealed a large hole at the staple line with a visible pigtail end at the collection site.
The bleeding was thereafter controlled after removal of the stent. The patient was kept nil per mouth (NPO) and put on a high-dose proton pump inhibitor (PPI). A few weeks later, another long covered endoluminal stent was placed to seal the gastric leak, but the patient developed severe chest pain and tachycardia afterward. Unfortunately, the gastrograffin swallow revealed an esophageal perforation at the upper edge of the stent that had eroded and perforated the esophagus at the mid-esophageal level (Fig. 3). The patient was taken to the operating room for emergency repair.
Figure 3. Fluorography showing the esophageal perforation site.
Thoracoscopic repair attempts failed due to excessive bleeding and poor visualization of the perforation. Open thoracotomy was then performed, followed by endoscopic removal of the stent, placement of a nasojejunal feeding tube under direct visualization, primary closure of the esophageal perforation using double-layer repair, and placement of the right chest tube. A few days later, contrast studies revealed dehiscence of the esophageal repair, with the esophageal contents leaking into the right chest tube with a persistent gastric leak through the percutaneous pigtail drainage. At this stage, a multidisciplinary conference was convened, and a decision was made to continue a conservative management approach only. He was kept on NPO and nasojejunal feeding alternating with PN for several months without noticeable improvement of both the esophageal and gastric leaks.
Later imaging showed migration of the abdominal pigtail catheter into the gastric lumen through the large gastric hole. Instead of repositioning of the drain, it was removed, and an internal drain (double J stent) was placed percutaneously, with one end looped in the stomach and the other kept unlooped to anchor it in place to avoid stent dislodgment. Fortunately, this was successful in managing the gastric leak internally. A few attempts to embolize the esophageal leak with coils and glue were unsuccessful, with the dislodgment of the coils shown in follow-up studies. Eventually, the esophageal leak was successfully embolized using a plug (type 2 Amplatzer, 8 mm) sealed with a cohesive agent (Figs. 4 and 5). After two weeks, follow-up contrast studies showed no leakage, neither from the esophagus nor from the gastric holes. The patient was placed on clear liquid and then advanced to a full liquid diet. The pleural drain was removed, and he was discharged home. He was then placed on a regular diet one month after hospital discharge without any issues. His second visit after 3 months to the clinic showed no clinical or biological evidences of sepsis or malnutrition. However, he was not walking well due the long hospital stays on bed. He was advised to go for intensive physical and functional rehabilitation at his hometown.
Figure 4. Amplatzer septal occluder device
Figure 5. The septal occluder in place after deployment into the esophageal perforation.
Gastric leak after sleeve gastrectomy is associated with a significant morbidity and mortality rate of greater than 0.14% [12]. Leaks after LSG remain one of the most feared complications. They can present as acute (within 1–2 weeks), early (within 6 weeks), and late leaks (after 6 weeks) with a contained abscess and sepsis, as in our case [13]. The ideal intervention after a confirmed leak post-sleeve gastrectomy depends on the time of presentation and the available resources and expertise. Most authors recommend surgical intervention for acute leaks to control sepsis, with or without primary repair, abdominal washout, and adequate drainage [14]. Early leaks are usually contained; therefore, the best option is to drain the collection area and control the leak site by endoluminal stenting or double pigtail internal drainage, depending on the perforation size and available resources and expertise [15]. Late leaks, however, are more challenging due to the chronicity of the leak site and its refractory nature to most interventions. Our patient experienced a significant leak, with the opening size measuring about 2 cm in diameter almost one year after the primary procedure. Although the patient was managed well initially with laparoscopic surgical intervention, less invasive interventions, such as interventional radiological drainage and insertion of the endoluminal stent, could have been a better option.
Endoscopic placement of fully covered stents is a minimally invasive and effective alternative to surgery for managing leaks after bariatric surgery. The reported success rate of leak closure is about 88% [16]. However, stents are not that easily tolerated by patients and have well-known complications, such as strictures, erosions with bleeding, and perforations that can be very challenging to manage, as happened to our patient. Recently, the internal drainage of gastric leaks using double pigtail catheters has emerged as an excellent alternative to endoluminal stents, as they have a much lower complication rate, very well tolerated by patients, and success rates are as effective as endoluminal stents [17,18]. Internal drainage; however, is more successful for small leaks (< 1> 1 cm), as it cannot hold in place [16]. In retrospect, insertion of a percutaneous pigtail catheter for our patient could have been an ideal step to start with before stent insertion, as it was an unfortunate and unexpected complication of esophago-gastric stenting, causing a challenging perforation. Diagnosis of esophageal perforation can be difficult, mainly due to non-specific symptoms. The patient’s chest pain was initially thought to be procedure-related. Repeat contrast studies should be obtained whenever there is clinical suspicion, even in patients with negative initial imaging studies [19].
Esophageal perforations continue to report high morbidity and mortality rates of more than 29% [20]. More than half of the perforations are iatrogenic and are mostly related to endoscopic instrumentation used in the upper gastrointestinal tract [21,22]. The risk of perforation after endoscopic esophageal stent placement can reach up to 25% [22]. Timely diagnosis and appropriate treatment of esophageal perforation remain challenging but essential for such patients. Surgical repair of esophageal perforation is a life-saving intervention, especially when performed within 24 hours of the event [23].
Currently, endoscopic management of esophageal perforations is preferred over surgical intervention, especially for hemodynamically stable patients [24]. Success rates of endoscopic interventions vary according to the perforation site and size. If the perforation is in the upper third, stenting is not applicable, and clipping is more appropriate. However, clipping is only possible for small perforations < 2> 2 cm, clipping is not applicable, and stents can be utilized [25].
Nonoperative treatment is also possible for some patients with iatrogenic perforation without systemic symptoms of infection and compromised hemodynamics. In such cases, careful observation, NPO, and appropriate treatment with intravenous broad-spectrum antibiotics, PPIs, and nutritional support may be sufficient for successful treatment [25,26].
Radiologically-guided methods for fistula closure include placement of mechanical agents such as coils and plugs and liquid embolic agents such as tissue glue (n-butyl two cyanoacrylates) and (ethylene-vinyl alcohol copolymer based liquid embolic). Coils are excellent embolizing agents in blood vessels. However, in the GI tract, a more stable mechanical agent is needed to resist dislodgment by peristalsis. The type 2 Amplatzer plug was a logical choice in our case, as it provides marked stability with its double configuration. Additionally, adding a sealing agent was critical to occlude the spaces between the wire mesh. While plugs are, in general, more expensive than coils, their stability makes them an excellent option for occluding fistulous tracts [27]. These mechanical agents, as well as liquid embolic agents, can be delivered via small catheters that can be placed transnasally without anesthesia [28].
The management of late gastric leaks after sleeve gastrectomy is challenging and refractory to many interventions. Judgmental non-surgical approaches, whether interventional radiology (IR) and/or endoscopic management of such leaks, should be considered depending on availability of the expertise and equipment. Surgical interventions are considered the last approach if IR and endoscopic interventions are not applicable or failed to control the leak site.
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
My Testimonial Covering as fellowing: Lin-Show Chin. 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.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
