Efficacy and Safety of Remimazolam versus Midazolam for Sedation during Endoscopic Ultrasound-Guided Tissue Acquisition in Patients with Solid Pancreatic Lesions.
OBJECTIVES Remimazolam is an ultra-short-acting benzodiazepine with a shorter pharmacokinetic half-life than midazolam. This study compared the efficacy and safety of remimazolam and midazolam for sedation during endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with solid pancreatic lesions. METHODS AND PATIENTS We retrospectively reviewed patients who underwent EUS-TA under remimazolam (August 2025-February 2026) or midazolam (January 2025-July 2025). The primary outcome was the time from procedure completion to patient awakening. Secondary outcomes included sedation success rate, time to sedation onset, total dose and number of doses, agitation requiring procedure interruption, flumazenil use, and sedation-related adverse events. RESULTS A total of 101 patients received remimazolam and 105 received midazolam. Median time from procedure completion to patient awakening was significantly shorter with remimazolam (2 min; interquartile range [IQR] 2-3) than with midazolam (4 min; IQR 3-5; P<0.01). The median total number of doses was higher with remimazolam (P<0.01), while flumazenil administration was significantly lower (P<0.01). Sedation success rate, time to sedation onset, agitation requiring procedure interruption, and adverse event rates did not differ significantly. CONCLUSION Remimazolam was associated with faster recovery and reduced flumazenil use, suggesting improved efficiency and safety in post-procedural monitoring, along with decreased staff workload after EUS-TA.