Valsalva maneuver to visualize the closed hypopharyngeal space during transoral endoscopy using a novel dedicated mouthpiece.

Patients with esophageal squamous cell carcinoma (ESCC) require careful endoscopic inspection of the pharynx to ensure the early detection of pharyngeal cancer. However, the visibility of the hypopharynx is poor because of closure of the lumen, and cancers in this area are often detected at an advanced stage. The Valsalva maneuver has been reported as a useful technique for opening the hypopharyngeal space, and thus, we have started to include the procedure using a dedicated mouthpiece (Valsamouth, MD-49700; Sumitomo Bakelite, Tokyo, Japan) as part of the pretreatment endoscopic examination in ESCC patients (Fig. 1). This article is protected by copyright. All rights reserved.