St Mary General hospital prime healthcare , NJ , USA Passaic, NJ
Abdallfatah Abdallfatah, 1, Bishoy Beshay, MD2, Mark Nasseem, MBBCh3, Imad Tahhan, MD4, Mohammad Kloub, MD5, Samaa Daoud, 6, Riddhi Machchhar, DO7, Salma Allam, 8, Ahmed Salem, MD9, Nermin Elhossiny, 10, Mohammed Y. Youssef, MD11, Mohamed Eldesouki, MD12, Omar Abdelhalim, MD13, Hazem Abosheaishaa, MD14 1Faculty of Medicine, October 6 University, Giza, Al Jizah, Egypt; 2Abington Jefferson Hospital, Linden, NJ; 3Ain Shams University, Cairo, Al Qahirah, Egypt; 4Academic Hospitalist, St. Francis Hospital, Linden, NJ; 5New York Medical College - Saint Michael's Medical Center, Bloomfield, NJ; 6Faculty of Medicine, October 6 University, Giza, Egypt, Cairo, Al Jizah, Egypt; 7Hackensack Meridian OUMC, Brick, NJ; 8Galala University, Suez, As Suways, Egypt; 9Maimonides Medical Center, New York , USA, New York, NY; 10St Mary General hospital prime healthcare , NJ , USA, Passaic, NJ; 11Hunt Regional Medical Center, Greenville, TX; 12Saint Michael's Medical Center, New York Medical College, Newark, NJ; 13Icahn School of Medicine at Mount Sinai, Queens, NY; 14Mount Sinai West, Icahn School of Medicine at Mount Sinai, Queens, NY 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). Discussion: 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.
Figure: PRISMA Flow Chart
Figure: Forest plots display the analyses of hypotension rate
Disclosures: Abdallfatah Abdallfatah indicated no relevant financial relationships. Bishoy Beshay indicated no relevant financial relationships. Mark Nasseem indicated no relevant financial relationships. Imad Tahhan indicated no relevant financial relationships. Mohammad Kloub indicated no relevant financial relationships. Samaa Daoud indicated no relevant financial relationships. Riddhi Machchhar indicated no relevant financial relationships. Salma Allam indicated no relevant financial relationships. Ahmed Salem indicated no relevant financial relationships. Nermin Elhossiny indicated no relevant financial relationships. Mohammed Y. Youssef indicated no relevant financial relationships. Mohamed Eldesouki indicated no relevant financial relationships. Omar Abdelhalim indicated no relevant financial relationships. Hazem Abosheaishaa indicated no relevant financial relationships.
Abdallfatah Abdallfatah, 1, Bishoy Beshay, MD2, Mark Nasseem, MBBCh3, Imad Tahhan, MD4, Mohammad Kloub, MD5, Samaa Daoud, 6, Riddhi Machchhar, DO7, Salma Allam, 8, Ahmed Salem, MD9, Nermin Elhossiny, 10, Mohammed Y. Youssef, MD11, Mohamed Eldesouki, MD12, Omar Abdelhalim, MD13, Hazem Abosheaishaa, MD14. P0861 - Remimazolam versus Propofol for Gastrointestinal Endoscopic Sedation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
