S1250 Remimazolam Versus Propofol for Gastrointestinal Endoscopic Sedation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Gastrointestinal endoscopy is one of the most performed procedures worldwide, it often requires sedation to enhance patient satisfaction and procedural outcomes. Propofol is preferred sedative due to its rapid onset and recovery, though it has adverse effects like hypotension and respiratory depression. Recently, remimazolam has emerged as a promising sedative. Our aim is to evaluate the efficacy and safety profile of remimazolam as an alternative to propofol. Methods: We performed a systematic review and meta-analysis according to PRISMA guidelines and registered our study in PROSPERO database (CRD42025635440). We performed a literature search through WOS, Scopus, Medline and Embase databases from inception up to December 31, 2024. Two reviewers carried out data extraction and quality assessment independently, a third author resolved the conflicts. Our primary outcome was hypotension. We performed meta-analysis using RevMan version 5.4. Results: We included 29 Randomized controlled trials. The overall risk of bias was low to moderate. Remimazolam demonstrated significantly lower hypotension risk (27 studies, OR: 0.26, 95% CI: 0.21–0.33; P < 0.00001). Additionally, it showed Lower respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), Reduced injection site pain (OR: 0.09; P < 0.00001. Lower to no difference sedation success rate for remimazolam vs Propofol (13 studies, OR: 0.44, 95% CI: 0.28–0.69; P = 0.0004; I² 0%). Higher patient satisfaction with remimazolam (8 studies; MD: 0.43, 95% CI: 0.16–0.70; P < 0.00001). Conclusion: Our systematic review and meta-analysis demonstrated that remimazolam has clinically similar efficacy, superior hemodynamic stability, greater safety profile and Higher patient satisfaction when compared with propofol for sedation in gastrointestinal endoscopy.