{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:29:27Z","timestamp":1786598967930,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Sedation is an essential component of upper gastrointestinal endoscopy because it reduces patient discomfort and anxiety while improving patient acceptance and procedural quality. In Japan, benzodiazepines such as midazolam and opioid analgesics have long been widely used in routine clinical practice; however, many of these agents historically lacked formal insurance approval for sedation during gastrointestinal endoscopy. Propofol is also a useful sedative because of its rapid onset and recovery, but its use in Japan has been limited because of concerns regarding respiratory and cardiovascular depression and the need for management by anesthesia\u2010trained personnel. Against this background, the approval of remimazolam for sedation during gastrointestinal endoscopy in June 2025 represented a major turning point in Japanese endoscopic sedation practice. Remimazolam is an ultra\u2010short\u2010acting benzodiazepine rapidly metabolized by carboxylesterases and reversible with flumazenil. Japanese phase III trials demonstrated high sedation success rates and rapid recovery during upper gastrointestinal endoscopy, including in elderly patients. Compared with midazolam, remimazolam shortened awakening and ambulation times, whereas compared with propofol, it may cause fewer respiratory and cardiovascular adverse events. This review summarizes the current status of upper gastrointestinal endoscopic sedation in Japan, focusing on the clinical evidence and positioning of the newly approved ultra\u2010short\u2010acting benzodiazepine, remimazolam.<\/jats:p>","DOI":"10.1002\/deo2.70402","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:17:44Z","timestamp":1786598264000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Update on Sedation for Upper Gastrointestinal Endoscopy in Japan: Current Evidence on Remimazolam"],"prefix":"10.1002","volume":"7","author":[{"given":"Ryoji","family":"Ichijima","sequence":"first","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Toyama","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo 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Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiko","family":"Mizuguchi","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoya","family":"Toyoshima","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Takamaru","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Yamada","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masau","family":"Sekiguchi","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"},{"name":"Division of Screening Technology National Cancer Center Institute for Cancer Control  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiichiro","family":"Abe","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Saito","sequence":"additional","affiliation":[{"name":"Endoscopy Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/den.13882","article-title":"Guidelines for Sedation in 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for High\u2010Risk Patients Such as Those With Cirrhosis?","volume":"35","author":"Ichijima R.","year":"2023","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_16_6_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.gie.2017.07.018","article-title":"Guidelines for Sedation and Anesthesia in GI Endoscopy","volume":"87","author":"Early D. 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