Role of remimazolam in gastrointestinal endoscopy: American Society for Gastrointestinal Endoscopy clinical practice update
In brief
New endoscopy guidance adds remimazolam as a sedation option
An American Society for Gastrointestinal Endoscopy update reviews evidence on remimazolam for procedural sedation, including its efficacy, safety, dosing, and use in patient selection. The drug offers rapid onset, short duration, and metabolism independent of organ function, but the update does not provide a single comparative effect estimate; clinicians will need to weigh the evidence for individual patients.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 7 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Daryl Ramai, Markus W Hollmann, Sudipta Sen, Faisal Ali, Sara Ghoneim, Sydney Greenberg, et al.
- PMID
- 42848339
- DOI
- 10.1016/j.gie.2026.08.019
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 9 October 2026): Sedation guideline update, informs endoscopy practice
Abstract
This clinical practice update provides evidence-based recommendations on the use of remimazolam, a novel ultra-short-acting benzodiazepine, for procedural sedation during GI endoscopy. Remimazolam was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. It offers rapid onset, short duration of action, and organ-independent metabolism, making it an alternative to traditional sedatives such as midazolam and propofol. This update synthesizes data from randomized controlled trials, meta-analyses, and real-world studies, addressing efficacy, safety, dosing, and patient selection. It aims to assist clinicians in optimizing sedation while minimizing risks, particularly in high-risk populations. Previous guidelines, such as the 2018 American Society for Gastrointestinal Endoscopy guidelines on sedation and anesthesia in GI endoscopy, focused on midazolam and propofol but did not include remimazolam. This update incorporates emerging evidence to guide the integration of remimazolam into practice.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.