Endoscopists with inadequate access to standard per- sonal protective equipment (PPE) are being exposed to droplets from patients, some of whom may be positive for COVID-19, during upper endoscopy. Herein, we describe how a ready-made mouthpiece with a barrier (Valsa-mouth [Fig. 1A]; Sumitomo Bakelite Co, Ltd, Shinagawa-ku, Japan) may help protect endoscopists during endoscopic procedures. The mouthpiece was designed for the Valsalva maneuver, a forceful attempted exhalation against a closed airway to allow observation of the hypopharynx. The mouthpiece consists of a small hole through which an endoscope is attached and is able to close the patient’s airways with the exception of the nose.
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