Issa IA, Lakis R, Issa T. Sedation in endoscopy: Finding the balance between safety and efficacy. World J Gastrointest Endosc 2025; 17(8): 109695 [PMID: 40838158 DOI: 10.4253/wjge.v17.i8.109695]
Reader's ID:
06196607
Submitted on:
August 16, 2025, 18:44
Reader Expertise:
Reader’s expertise on the topic of the manuscript
Conflicts-of-Interest Statement:
Does the reader have a conflict of interest?
Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
Does the manuscript meet the requirements of biostatistics?
10 Units
Does the manuscript meet the requirements of use of SI units?
11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
Language Quality:
Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
Issa and colleagues provide a timely, practice-oriented overview of sedation in GI endoscopy and rightly emphasize balancing efficacy, safety, and cost. Their focus on opioid-sparing strategies is particularly relevant for ambulatory units.
The trial they highlight (midazolam alone vs midazolam–fentanyl) suggests that, in selected low-risk cases, opioids may be unnecessary without sacrificing patient comfort or procedural success. Important limitations—single-operator design, higher midazolam dosing, and hints of longer cecal intubation—temper generalizability and justify replication.
2) On delivery models, non-anesthesiologist propofol can be safe when programs use formal training, selection (ASA I–II), and robust monitoring; remimazolam is promising for hemodynamic stability but still needs head-to-head pragmatic trials that include recovery time and cost.
A pragmatic pathway could be: (1) short, low-nociception diagnostics in ASA I–II → midazolam-based moderate sedation (consider midazolam alone); (2) prolonged/therapeutic cases → propofol with trained teams; (3) high-risk or deep sedation anticipated → anesthesiology support and full physiologic monitoring. Governance should track adverse events, patient-reported outcomes, recovery, and cost per completed case.
Reply from the Editorial Office:
Thank you very much for your comments.