{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:56:04Z","timestamp":1791924964310,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,1,21]],"date-time":"2019-01-21T00:00:00Z","timestamp":1548028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Simultaneous and metachronous head and neck cancers are likely to develop in patients with current or previous esophageal cancer. The Valsalva maneuver facilitates the visualization of the hypopharyngeal area during endoscopic observation, but it requires transnasal endoscopy. We developed a novel Valsalva maneuver using transoral endoscopy with a lip cover\u2010type mouthpiece.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between March 2018 and July 2018, 107 patients with current or previous esophageal cancer who were scheduled to undergo upper gastrointestinal endoscopy were included in our pilot study. We performed the Valsalva maneuver using our newly developed mouthpiece and transoral endoscopy in the patients and evaluated the hypopharyngeal region, including the postcricoid area and the posterior wall of the hypopharynx. The outcome measure was procedural success rate, which was graded as \u201ccomplete,\u201d \u201cincomplete,\u201d and \u201cnone.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Observation of the hypopharyngeal area was \u201ccomplete\u201d in 81 patients (76%) using the Valsalva maneuver. However, in 25 patients and in 1 patient, observation was \u201cincomplete\u201d and \u201cnone,\u201d respectively. Seven lesions were newly detected in seven patients during the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Valsalva maneuver using transoral endoscopy with a lip cover\u2010type mouthpiece is feasible for the visualization of the postcricoid area and the posterior wall of the hypopharynx. Particularly, this technique would contribute to early detection of head and neck cancers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.14574","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T13:49:48Z","timestamp":1545140988000},"page":"1384-1389","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pharyngeal observation via transoral endoscopy using a lip cover\u2010type mouthpiece"],"prefix":"10.1111","volume":"34","author":[{"given":"Taro","family":"Iwatsubo","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Oncology Osaka International Cancer Institute  Osaka Japan"},{"name":"Second Department of Internal Medicine Osaka Medical College  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryu","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Osaka International Cancer 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