Abstract
ABSTRACT
Objectives
Remimazolam is an ultra‐short‐acting benzodiazepine recently approved for endoscopic procedures in Japan as a sedative agent. We aimed to compare the efficacy and safety of remimazolam and midazolam for endoscopic retrograde cholangiopancreatography (ERCP)‐related procedures.
Methods
ERCP‐related procedures performed under sedation with remimazolam (between August 2025 and November 2025) and midazolam (between April 2025 and July 2025) were retrospectively reviewed. The primary outcome was the time from the end of the procedure to patient awakening and readiness for discharge. The secondary outcomes included sedation success throughout the procedure, time from the initial dose to achieving sedation, dosage, rate of antagonist use for awakening, and sedation‐related adverse events.
Results
Eighty‐eight patients underwent ERCP‐related procedures with remimazolam and 86 with midazolam. The median times from the end of the procedure to patient awakening and readiness for discharge with remimazolam and midazolam were 2 min (interquartile range [IQR], 1–3) and 4 min (IQR, 3–5), respectively. Sedation with remimazolam required a shorter time to awaken than sedation with midazolam (
p
p
p
= 0.49, 0.13, and 0.27, respectively).
Conclusions
Remimazolam demonstrated significantly shorter time to patient awakening, suggesting a safer and more efficient discharge process after ERCP‐related procedures.