So yeah, this is the, this is what we're aiming for. It's superior to any type of prep. This group already seems to know how to use it but essentially take half the evening prior, you finish the set you start the second dose four to six hours before the colonoscopy. And the goal is to complete the last dose at least two hours before. This has been supported by meta-analyses showing better cleansing, less likely for patients to discontinue the prep, there was willingness to repeat the prep on the patient's part and a reduction in nausea. This translates into improved adenoma detection of split dose preps compared to taking all the prep the day before. And in terms of whether a low volume or a high volume prep is needed, there does not seem to be a huge difference when looked at in terms of large scale trials, you may see individual differences in your practice, depending on your patient population, other medications they might be taking or other issues that you might be seeing so, but in general the evidence would support kind of any of the prep options that are approved, or even the lower volume over the counter prep. So what are the, you know, in terms of splitting the dose, what are the potential barriers? Well, a lot of people have questions of whether patients will accept the idea of getting up early in the morning to take that second dose before a morning procedure but 85% of people surveyed are willing to get up at night to take their prep and 78% actually complied. People worry about the need to use the restroom on the way to the procedure like the drive in, but there was really no difference in the need to use the bathroom on the way to a colonoscopy, depending on whether it was split dose or day before, and people worried about patients not compliant with pre procedure fasting guidelines or increased risk of aspiration. So we'll kind of talk a little bit about that. It generally seems that you can accommodate clear liquids, up to two hours prior to the procedure with relatively low risk of aspiration. So we don't, this does not seem to be a big concern at all as long as you have at least two hours from the last clear liquid. There are, there's some growing interest in particularly if you're doing afternoon cases to take the full dose at 6am the day of the procedure. That's certainly superior to taking everything the day before. If you use a low volume morning prep, it's comparable to a low volume split dosing. People are less likely to lose sleep or have bloating compared to the evening or the split dose prep, and there's less interference with work schedule. This is just some evidence demonstrating potential superior percentage of patients with a quote unquote good prep when it's taken, when everything's taken the same day as the procedure. Adenoma detection rate seems to be very similar between the same day and split dose bell preparations.

split dose bowel preparations

colonoscopy procedures

better cleansing

increased patient compliance

reduced side effects