Efficacy and adverse reactions of remimazolam and propofol in patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis.

[BACKGROUND] Gastrointestinal (GI) endoscopy is crucial for detecting suspicious gastric lesions, screening for gastric cancer, and providing early diagnosis. With an aging population, an increasing number of elderly individuals require gastrointestinal endoscopy.

[METHODS] Four databases were searched to acquire controlled clinical trials on the effects of remimazolam and propofol in patients undergoing GI endoscopy. A meticulous evaluation of the literature quality and data was then performed using Stata software.

[RESULTS] Seventeen studies reported significantly lower respiratory depression in the experimental group compared to the control group (odds ratio: OR 0.28; 95% confidence interval (CI): 0.18-0.45; P<0.01). Injection pain (OR: 0.11; 95% CI: 0.06-0.20; P<0.01), hypotension (OR: 0.41; 95% CI: 0.33-0.52; P<0.01), and hypoxemia (OR: 0.38; 95% CI: 0.22-0.63; P<0.01) were also significantly lower in the experimental group. However, propofol was associated with improved sedation success (OR: 0.99; 95% CI: 0.98-1.00; P=0.048) and longer sedation time (SMD: 24.19; 95% CI: 14.60-33.79; P<0.01). Recovery time showed no significant difference between groups (SMD: -0.27; 95% CI: -1.46-0.92; P=0.657).

[CONCLUSION] This study suggests that both remimazolam and propofol are efficacious in patients undergoing gastrointestinal endoscopy. Remimazolam significantly reduces complications such as respiratory depression, injection pain, hypotension, and hypoxemia. However, propofol has advantages in improving sedation success and sedation time. These findings are supported by high-quality randomized controlled trials.