This clinical practice update provides evidence-based recommendations on the use of remimazolam, a novel ultra-short-acting benzodiazepine, for procedural sedation during GI endoscopy. Remimazolam was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. It offers rapid onset, short duration of action, and organ-independent metabolism, making it an alternative to traditional sedatives such as midazolam and propofol. This update synthesizes data from randomized controlled trials, meta-analyses, and real-world studies, addressing efficacy, safety, dosing, and patient selection. It aims to assist clinicians in optimizing sedation while minimizing risks, particularly in high-risk populations. Previous guidelines, such as the 2018 American Society for Gastrointestinal Endoscopy guidelines on sedation and anesthesia in GI endoscopy, focused on midazolam and propofol but did not include remimazolam. This update incorporates emerging evidence to guide the integration of remimazolam into practice.

Serrated polyposis syndrome (SPS) is the most common polyposis syndrome, yet SPS often goes unrecognized. SPS diagnosis is based on clinical criteria established by the World Health Organization and includes the size, cumulative lifetime number, and location of serrated polyps throughout the colon. Individuals with SPS have an increased risk of prevalent and incident colorectal cancer (CRC). Meticulous inspection, clearing of the colon and frequent surveillance colonoscopy is recommended to decrease incident CRC. Colorectal surgery is indicated for individuals diagnosed with cancer or whose polyp burden cannot be managed endoscopically by expert endoscopists. There is no common germline pathogenic variant associated with SPS. Germline genetic testing is indicated only in individuals who meet criteria for a known hereditary syndrome in the appropriate clinical setting. First-degree relatives of patients with SPS are at heightened risk of CRC and should undergo colonoscopic screening.