Efficacy and safety of remimazolam for sedation in gastrointestinal endoscopy: a systematic review and meta-analysis.

BACKGROUND

Gastrointestinal endoscopy serves as a key tool for diagnosing and treating digestive disorders. Adequate sedation is indispensable in achieving ideal surgical outcomes and promoting patient comfort. Recently, remimazolam has been utilized more frequently because of its good safety features, brief action time and rapid onset. This study aims to systematically review and meta-analyze remimazolam's effectiveness and safety profile in sedating patients undergoing gastrointestinal endoscopies.

METHODS

We conducted literature searches in Embase, PubMed, and the Cochrane Library databases, covering the period from the establishment of each database to January 31, 2026 for all relevant CCTs and RCTs that discussed remimazolam sedation for gastrointestinal endoscopy. RevMan software (version 5.4) was employed for all statistical analyses.

RESULTS

Eight trials involving 2,455 patients were included. In cardiovascular outcomes, remimazolam was linked to a significantly lower hypotension (RR = 0.59; 95% CI: 0.43-0.81) and bradycardia (RR = 0.42; 95% CI: 0.25-0.71) risks compared with midazolam and propofol. For respiratory adverse events, remimazolam demonstrated notably reduced rates of apnea (RR = 0.51; 95% CI: 0.30-0.88), oxygen desaturation (RR = 0.20; 95% CI: 0.08-0.52) and diminished respiratory compromise (RR = 0.45; 95% CI: 0.23-0.87). Regarding patient comfort, remimazolam significantly reduced injection-related pain (RR = 0.20; 95% CI: 0.06-0.66).

CONCLUSION

Remimazolam may confer a favorable safety profile for procedural sedation in adults receiving gastrointestinal endoscopies. It could serve as a reliable and effective alternative to conventional sedatives.