Sedation has become a global standard in gastrointestinal endoscopy. Although the Korean Society of Gastrointestinal Endoscopy (KSGE) published guidelines in 2021, real-world practice and perspectives from nurses and patients remain unclear. This study aimed to evaluate current sedation practices in Korea through a nationwide multi-stakeholder survey.

A cross-sectional survey was conducted between August 2024 and April 2025 among endoscopists (KSGE), endoscopy nurses (Korean Society of Gastrointestinal Endoscopy Nurses and Associates), and patients at two university hospitals. Questionnaires assessed demographics, sedation practices, safety protocols, training, and patient knowledge and attitudes.

A total of 735 endoscopists, 247 nurses, and 204 patients participated. Most endoscopists reported routine sedation (≥76% in 69.9% of upper endoscopies and 90.8% of colonoscopies), with propofol-based regimens predominating. Sedation training improved markedly (92.0%), but CPR/BLS training remained stagnant (57.6%). Although overall complication rates declined slightly, severe adverse (intubation 18.1%, and mortality 3.6%) increased. Nurses showed higher completion rates for sedation and CPR/BLS training and greater adherence to ASA/Mallampati assessment, continuous monitoring, and standardized discharge protocols.  Patients chose sedation mainly for pain reduction (87.3%), but demonstrated limited knowledge of sedatives with 55.1% unaware of post-procedure driving restrictions and related legal penalties. While safety was the top priority, many expressed willingness to pay for effective and safe agents, suggesting interest in newer options such as remimazolam. 

Sedation practices in Korea are now highly standardized, supported by guidelines, training, and nursing involvement. However, rising severe complications and persistent patient knowledge gaps highlight the need for risk-focused refinement, wider CPR/BLS training, adoption of advanced monitoring, and reinforced patient education.