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Update on Sedation for Upper Gastrointestinal Endoscopy in Japan: Current Evidence on Remimazolam
Ryoji Ichijima1, Masahiro Toyama1, Taiki Shishido1
1Endoscopy Division National Cancer Center Hospital Tokyo Japan.
DEN Open
|August 14, 2026
Summary
Remimazolam, a new ultra-short-acting benzodiazepine, offers improved sedation for upper gastrointestinal endoscopy in Japan. It provides rapid recovery and potentially fewer adverse events compared to traditional agents.
Area of Science:
- Gastroenterology
- Pharmacology
- Anesthesiology
Background:
- Sedation is crucial for upper gastrointestinal endoscopy, enhancing patient comfort and procedural quality.
- Traditional sedatives like midazolam and propofol have limitations in Japan, including lack of insurance approval and safety concerns.
- Remimazolam, an ultra-short-acting benzodiazepine, has been approved for endoscopic sedation in Japan.
Purpose of the Study:
- To review the current landscape of upper gastrointestinal endoscopic sedation in Japan.
- To evaluate the clinical evidence and positioning of remimazolam for endoscopic sedation.
- To highlight remimazolam's advantages over existing sedative agents.
Main Methods:
- Review of Japanese phase III clinical trials for remimazolam.
- Comparison of remimazolam's efficacy and safety with midazolam and propofol.
- Analysis of remimazolam's pharmacokinetic and pharmacodynamic properties.
Main Results:
- Remimazolam demonstrated high sedation success rates and rapid recovery in upper gastrointestinal endoscopy, including in elderly patients.
- Compared to midazolam, remimazolam significantly shortened awakening and ambulation times.
- Remimazolam may offer a better safety profile regarding respiratory and cardiovascular adverse events compared to propofol.
Conclusions:
- Remimazolam represents a significant advancement in Japanese endoscopic sedation practices.
- Its rapid metabolism, reversibility, and favorable safety profile position it as a valuable alternative to midazolam and propofol.
- Further research may solidify remimazolam's role in optimizing endoscopic procedures.
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