{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:04:16Z","timestamp":1793271856525,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Gastroenterol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Sedation is increasingly essential for gastrointestinal endoscopy. Remimazolam, an ultra-short-acting benzodiazepine, has a shorter pharmacokinetic half-life than midazolam. The aim of this study was to determine whether remimazolam provides superior procedural sedation in Japanese patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cohort of this prospective, multicenter, randomized, single-blind controlled trial comprised adults (18\u201380\u00a0years) scheduled for sedated upper gastrointestinal endoscopy. Participants were randomized to remimazolam and midazolam groups. The primary outcome was the proportion of ambulatory patients 5\u00a0min after endoscopy. Secondary outcomes were successful pre-procedure sedation (Modified Observer\u2019s Assessment of Alertness\/Sedation\u2009\u2264\u20094), dose of sedative to achieve sedation, time to ambulation, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From October 2024 to January 2025, 40 patients were enrolled. After excluding two outliers 38 were analyzed (remimazolam, n\u2009=\u200920; midazolam, n\u2009=\u200918). Ambulation at 5\u00a0min occurred in 85.0% (17\/20) of the remimazolam versus 0.0% (0\/18) of the midazolam group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Mean time from procedure end to walking was 4.25\u00a0min (range 0.0\u201310.0) for remimazolam and 35.56\u00a0min (10.0\u201360.0) for midazolam (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Pre-procedure sedation was successful (MOAA\/S\u2009\u2264\u20094) in 100% of both groups. Mean doses to achieve sedation were 4.30\u00a0mg (3.0\u20137.0) for remimazolam and 3.11\u00a0mg (2.0\u20135.0) for midazolam (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Hypoxemia occurred in 5.0% of the remimazolam and 33.3% of the midazolam group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In upper gastrointestinal endoscopy, remimazolam achieved markedly faster recovery and a lower incidence of hypoxemia than midazolam. Rates of achieving target sedation were equivalent. These findings indicate remimazolam is an effective and potentially safer sedative option for Japanese patients undergoing endoscopy.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration<\/jats:italic>\n                      : This research was registered with the Japan Registry of Clinical Trials (trial number jRCTs071240062) on September 26, 2024.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00535-025-02324-x","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T06:58:33Z","timestamp":1763362713000},"page":"241-249","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy and recovery of remimazolam versus midazolam in sedated upper gastrointestinal endoscopy: a multicenter randomized controlled trial in Japan (RECOVER Study)"],"prefix":"10.1007","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9782-9998","authenticated-orcid":false,"given":"Daisuke","family":"Yamaguchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoji","family":"Ichijima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisatomo","family":"Ikehara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Minoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Esaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Takamori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiyoshi","family":"Yoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeko","family":"Shirouzu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kento","family":"Sadashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Fujimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Shimamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Takedomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Akutagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanae","family":"Tsuruoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhisa","family":"Sakata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Kusano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Shimoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Esaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"issue":"6","key":"2324_CR1","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1111\/den.12678","volume":"28","author":"K Kashiwagi","year":"2016","unstructured":"Kashiwagi K, Hosoe N, Takahashi K, Nishino H, Miyachi H, Kudo SE, et al. Prospective, randomized, placebo-controlled trial evaluating the efficacy and safety of propofol sedation by anesthesiologists and gastroenterologist-led teams using computer-assisted personalized sedation during upper and lower gastrointestinal endoscopy. Dig Endosc. 2016;28(6):657\u201364. https:\/\/doi.org\/10.1111\/den.12678.","journal-title":"Dig Endosc"},{"key":"2324_CR2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/den.13882","volume":"33","author":"T Gotoda","year":"2021","unstructured":"Gotoda T, Akamatsu T, Abe S, et al. Guidelines for sedation in gastroenterological endoscopy (second edition). Dig Endosc. 2021;33:21\u201353.","journal-title":"Dig Endosc"},{"issue":"7","key":"2324_CR3","doi-asserted-by":"publisher","DOI":"10.1038\/s41424-018-0032-5","volume":"9","author":"H Kinugasa","year":"2018","unstructured":"Kinugasa H, Higashi R, Miyahara K, Moritou Y, Hirao K, Ogawa T, et al. Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study. Clin Transl Gastroenterol. 2018;9(7):167. https:\/\/doi.org\/10.1038\/s41424-018-0032-5.","journal-title":"Clin Transl Gastroenterol"},{"key":"2324_CR4","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12876-017-0692-8","volume":"17","author":"D Yamaguchi","year":"2017","unstructured":"Yamaguchi D, Yamaguchi N, Takeuchi Y, Yukimoto T, Ikeda K, Matsumoto K, et al. Comparison of sedation between the endoscopy room and operation room during endoscopic submucosal dissection for neoplasms in the upper gastrointestinal tract. BMC Gastroenterol. 2017;17:127.","journal-title":"BMC Gastroenterol"},{"key":"2324_CR5","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1159\/000500874","volume":"101","author":"Y Takeuchi","year":"2020","unstructured":"Takeuchi Y, Yamaguchi D, Yamaguchi N, Ikeda K, Yoshioka W, Fukuda H, et al. Propofol sedation in the endoscopy room versus operation room during endoscopic submucosal dissection for gastric tumors: a propensity score-matching analysis. Digestion. 2020;101:450\u20137.","journal-title":"Digestion"},{"key":"2324_CR6","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1007\/s10620-022-07740-0","volume":"68","author":"D Yamaguchi","year":"2023","unstructured":"Yamaguchi D, Nagatsuma G, Sakata Y, Mizuta Y, Nomura T, Jinnouchi A, et al. Safety and efficacy of sedation during emergency endoscopy for upper gastrointestinal bleeding: a propensity score matching analysis. Dig Dis Sci. 2023;68:1426\u201334.","journal-title":"Dig Dis Sci"},{"issue":"2","key":"2324_CR7","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/S0016-5107(89)72713-9","volume":"35","author":"MG Lee","year":"1989","unstructured":"Lee MG, Hanna W, Harding H. Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam. Gastrointest Endosc. 1989;35(2):82\u20134. https:\/\/doi.org\/10.1016\/S0016-5107(89)72713-9.","journal-title":"Gastrointest Endosc"},{"issue":"5","key":"2324_CR8","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1111\/j.1365-2125.1988.tb05300.x","volume":"26","author":"GD Bell","year":"1988","unstructured":"Bell GD, Morden A, Coady T, Lee J, Logan RF. A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation. Br J Clin Pharmacol. 1988;26(5):595\u2013600. https:\/\/doi.org\/10.1111\/j.1365-2125.1988.tb05300.x.","journal-title":"Br J Clin Pharmacol"},{"issue":"1","key":"2324_CR9","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/S0016-5107(98)70299-8","volume":"47","author":"E Macken","year":"1998","unstructured":"Macken E, Gevers AM, Hendrickx A, Rutgeerts P. Midazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil. Gastrointest Endosc. 1998;47(1):57\u201361. https:\/\/doi.org\/10.1016\/S0016-5107(98)70299-8.","journal-title":"Gastrointest Endosc"},{"issue":"3","key":"2324_CR10","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/S0016-5107(93)70113-3","volume":"39","author":"JG Carrougher","year":"1993","unstructured":"Carrougher JG, Kadakia S, Shaffer RT, Barrilleaux C. Venous complications of midazolam versus diazepam. Gastrointest Endosc. 1993;39(3):396\u20139. https:\/\/doi.org\/10.1016\/S0016-5107(93)70113-3.","journal-title":"Gastrointest Endosc"},{"issue":"7","key":"2324_CR11","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1111\/den.14625","volume":"35","author":"R Ichijima","year":"2023","unstructured":"Ichijima R. What is the best sedation method for high-risk patients such as those with cirrhosis? Dig Endosc. 2023;35(7):855\u20136. https:\/\/doi.org\/10.1111\/den.14625.","journal-title":"Dig Endosc"},{"key":"2324_CR12","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.chest.2018.09.015","volume":"155","author":"NJ Pastis","year":"2019","unstructured":"Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, et al. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest. 2019;155:137\u201346.","journal-title":"Chest"},{"key":"2324_CR13","doi-asserted-by":"crossref","unstructured":"Rex DK, Bhandari R, Desta T, DeMicco MP, Schaeffer C, Etzkorn K, et al. A phase III study evaluating the efficacy and safety of remimazolam (CNS 7056) compared with placebo and midazolam in patients undergoing colonoscopy. Gastrointest Endosc. 2018;88:427\u2013437.e6. e426.","DOI":"10.1016\/j.gie.2018.04.2351"},{"issue":"1","key":"2324_CR14","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.dld.2020.10.039","volume":"53","author":"DK Rex","year":"2021","unstructured":"Rex DK, Bhandari R, Lorch DG, Meyers M, Schippers F, Bernstein D. Safety and efficacy of remimazolam in high risk colonoscopy: a randomized trial. Dig Liver Dis. 2021;53(1):94\u2013101. https:\/\/doi.org\/10.1016\/j.dld.2020.10.039.","journal-title":"Dig Liver Dis"},{"issue":"2","key":"2324_CR15","doi-asserted-by":"publisher","first-page":"384","DOI":"10.4314\/ahs.v22i2.44","volume":"22","author":"L Zhang","year":"2022","unstructured":"Zhang L, Li C, Zhao C, You Y, Xu J. The comparison of remimazolam and midazolam for the sedation of gastrointestinal endoscopy: a meta-analysis of randomized controlled studies. Afr Health Sci. 2022;22(2):384\u201391. https:\/\/doi.org\/10.4314\/ahs.v22i2.44.","journal-title":"Afr Health Sci"},{"issue":"7","key":"2324_CR16","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1111\/den.14365","volume":"34","author":"R Ichijima","year":"2022","unstructured":"Ichijima R, Ikehara H, Maeda T, Sugita T, Horii T, Iwao A, et al. First dose-ranging study of remimazolam in Japanese patients undergoing gastrointestinal endoscopy: phase II investigator-initiated clinical trial. Dig Endosc. 2022;34(7):1403\u201312. https:\/\/doi.org\/10.1111\/den.14365.","journal-title":"Dig Endosc"},{"issue":"1","key":"2324_CR17","doi-asserted-by":"publisher","DOI":"10.1002\/deo2.70057","volume":"5","author":"R Ichijima","year":"2025","unstructured":"Ichijima R, Ikehara H, Yamaguchi D, Nagata Y, Ogura K, Esaki M, et al. Usefulness and safety of remimazolam in upper gastrointestinal endoscopy: a comparative study between elderly and non-elderly patients. DEN Open. 2025;5(1):e70057. https:\/\/doi.org\/10.1002\/deo2.70057.","journal-title":"DEN Open"},{"issue":"9","key":"2324_CR18","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/den.14758","volume":"36","author":"R Ichijima","year":"2024","unstructured":"Ichijima R, Ikehara H, Yamaguchi D, Nagata Y, Ogura K, Esaki M, et al. Randomized controlled trial of remimazolam compared with placebo in Japanese patients undergoing upper gastrointestinal endoscopy: phase III investigator-initiated clinical trial. Dig Endosc. 2024;36(9):995\u20131002. https:\/\/doi.org\/10.1111\/den.14758.","journal-title":"Dig Endosc"},{"key":"2324_CR19","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1159\/000540527","volume":"105","author":"R Ichijima","year":"2024","unstructured":"Ichijima R, Ikehara H, Ono H, Hotta K, Yamaguchi D, et al. Randomized controlled trial of remimazolam compared with placebo in Japanese patients undergoing colonoscopy: a phase III, investigator-initiated trial. Digestion. 2024;105:448\u201356.","journal-title":"Digestion"},{"issue":"04","key":"2324_CR20","doi-asserted-by":"publisher","DOI":"10.1055\/a-1743-1936","volume":"10","author":"VA Dao","year":"2022","unstructured":"Dao VA, Schippers F, St\u00f6hr T. Efficacy of remimazolam versus midazolam for procedural sedation: post hoc integrated analyses of three phase 3 clinical trials. Endosc Int Open. 2022;10(04):E378-85. https:\/\/doi.org\/10.1055\/a-1743-1936.","journal-title":"Endosc Int Open"},{"issue":"5","key":"2324_CR21","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1080\/03007995.2023.2196198","volume":"39","author":"MH Pedersen","year":"2023","unstructured":"Pedersen MH, Dan\u00f8 A, Englev E, Kattenh\u00f8j L, Munk E. Economic benefits of remimazolam compared to midazolam and propofol for procedural sedation in colonoscopies and bronchoscopies. Curr Med Res Opin. 2023;39(5):691\u20139. https:\/\/doi.org\/10.1080\/03007995.2023.2196198.","journal-title":"Curr Med Res Opin"},{"key":"2324_CR22","doi-asserted-by":"publisher","first-page":"385","DOI":"10.4253\/wjge.v16.i7.385","volume":"16","author":"DS Dahiya","year":"2024","unstructured":"Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, et al. Remimazolam for sedation in gastrointestinal endoscopy: a comprehensive review. World J Gastrointest Endosc. 2024;16:385\u201395.","journal-title":"World J Gastrointest Endosc"},{"key":"2324_CR23","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12876-025-03636-1","volume":"25","author":"C Rita","year":"2025","unstructured":"Rita C, Flavia P, Anna C, Giuseppe G, Salvatore R, et al. Remimazolam for procedural sedation in gastrointestinal endoscopy: real-life, single center observational study. BMC Gastroenterol. 2025;25:41.","journal-title":"BMC Gastroenterol"},{"key":"2324_CR24","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s00228-024-03624-6","volume":"80","author":"W Ahmer","year":"2024","unstructured":"Ahmer W, Imtiaz S, Alam DM, Ahmed K, Sajid B, et al. Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2024;80:493\u2013503.","journal-title":"Eur J Clin Pharmacol"},{"issue":"4","key":"2324_CR25","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1111\/den.14948","volume":"37","author":"K Lee","year":"2025","unstructured":"Lee K, Jung DH, Lee SJ, Yoo YC, Shin SK. Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: randomized controlled study. Dig Endosc. 2025;37(4):391\u20139. https:\/\/doi.org\/10.1111\/den.14948.","journal-title":"Dig Endosc"},{"issue":"1","key":"2324_CR26","doi-asserted-by":"publisher","DOI":"10.1002\/deo2.412","volume":"5","author":"K Ogura","year":"2024","unstructured":"Ogura K, Ichijima R, Ikehara H, Sugita T, Yamaguchi D, Nagata Y, et al. Comparison of remimazolam and midazolam for sedation during colonoscopy in Japanese patients: a propensity score matching analysis. DEN Open. 2024;5(1):e412. https:\/\/doi.org\/10.1002\/deo2.412.","journal-title":"DEN Open"},{"issue":"1","key":"2324_CR27","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.70100","volume":"9","author":"R Ichijima","year":"2025","unstructured":"Ichijima R, Ikehara H, Sugita T, Yamaguchi D, Nagata Y, Ogura K, et al. Comparative Study of Remimazolam and Midazolam During Sedated Upper Gastrointestinal Endoscopy: A Propensity Score Matching Analysis. JGH Open. 2025;9(1):e70100. https:\/\/doi.org\/10.1002\/jgh3.70100.","journal-title":"JGH Open"},{"key":"2324_CR28","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/00004714-199008000-00003","volume":"10","author":"DA Chernik","year":"1990","unstructured":"Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and reliability of the observer\u2019s assessment of alertness\/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244\u201351.","journal-title":"J Clin Psychopharmacol"},{"key":"2324_CR29","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1111\/den.14995","volume":"37","author":"D Yamaguchi","year":"2025","unstructured":"Yamaguchi D, Esaki M. Remimazolam: a promising sedative for upper gastrointestinal endoscopy. Dig Endosc. 2025;37:400\u20131.","journal-title":"Dig Endosc"}],"container-title":["Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00535-025-02324-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00535-025-02324-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00535-025-02324-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:31:35Z","timestamp":1773394295000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00535-025-02324-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["2324"],"URL":"https:\/\/doi.org\/10.1007\/s00535-025-02324-x","relation":{},"ISSN":["0944-1174","1435-5922"],"issn-type":[{"value":"0944-1174","type":"print"},{"value":"1435-5922","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]},"assertion":[{"value":"16 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare that they have no conflicts of interest for this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Certified Review Board of Saga University Hospital (approval number C20240401), and the implementation plan was submitted to the Ministry of Health, Labour and Welfare of Japan. The principal investigator must obtain approval from the administrator of the medical institution to conduct the clinical study. Written informed consent was obtained from all study participants (jRCT; no. jRCTs071240062).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}