Synergistic Optimisation of Surface Properties and Surface Quality of FDM ABS Specimens Based on RSM and CWOA.

Upper gastrointestinal endoscopy is indispensable for the diagnosis and treatment of not only malignant tumors such as gastric cancer, esophageal cancer, and duodenal tumors, but also peptic ulcer disease, infectious disorders, and functional gastrointestinal diseases. In recent years, advances in diagnostic technologies such as image‐enhanced endoscopy and magnifying endoscopy, together with the development of therapeutic procedures including endoscopic submucosal dissection (ESD), have further increased the level of diagnostic and therapeutic accuracy required in upper gastrointestinal endoscopy. However, gag reflexes, nausea, anxiety, pain, and prolonged procedural duration impose a considerable burden on patients and may lead to procedural intolerance and body movement during treatment. Appropriate sedation is therefore important not only for reducing patient discomfort but also for maintaining a stable endoscopic field and endoscopic maneuverability. The demand for sedation during upper gastrointestinal endoscopy has increased in Japan. Elderly patients frequently undergo upper gastrointestinal endoscopy for screening, diagnosis, and treatment because the incidence of gastrointestinal malignancies is higher in this population. On the other hand, elderly patients have reduced cardiopulmonary reserve, impaired hepatic and renal function, cognitive dysfunction, swallowing impairment, and reduced muscle strength, making them more vulnerable to hypoxemia, hypotension, delayed recovery, falls, and aspiration associated with sedative administration []. Therefore, sedation strategies in Japanese upper gastrointestinal endoscopy must achieve an appropriate balance among adequate sedation, rapid recovery, and safety. In Japan, many outpatient endoscopic procedures are performed without anesthesiologist involvement because of limited medical resources and workforce imbalance. Before June 2025, few sedatives had formal insurance approval for gastrointestinal endoscopic sedation in Japan. Traditionally, benzodiazepines centered on midazolam have been widely used in Japanese endoscopic practice. However, for many years, these agents lacked formal approval for sedation during gastrointestinal endoscopy. Propofol is characterized by rapid induction and recovery, but because of its substantial effects on respiratory and hemodynamic stability, its administration generally requires supervision by physicians experienced in anesthesia management. Consequently, institutional and personnel limitations have restricted its widespread use in routine endoscopic practice in Japan. Against this background, the approval of remimazolam for sedation during gastrointestinal endoscopy in Japan in June 2025 represented an important milestone in Japanese endoscopic sedation practice. In this review, we summarize the current status of sedation in Japan and discuss the clinical role of remimazolam, focusing on diagnostic and therapeutic upper gastrointestinal endoscopy. Sedation practice in Japan has evolved under healthcare systems, drug approval processes, human resources, and clinical cultures distinct from those in Western countries. In Europe and North America, deep sedation using propofol with the involvement of anesthesiologists or anesthesia‐trained personnel is relatively common in some institutions. In contrast, sedation in Japan is frequently managed by endoscopists and endoscopy unit staff, and sedative selection is strongly influenced by safety and practical operability.