Split-dose bowel preparation versus water exchange and adenoma detection rate: have we arrived there yet?

Inadequate bowel preparation in screening colonoscopy interferes with adenoma detection, reduces the adenoma detection rate (ADR: the proportion of patients with at least one adenoma of any size), and increases the risk of interval colorectal cancers (those diagnosed within 3-5 years of the index screening examination). Studies with split-dose bowel preparation focused primarily on achieving adequacy of bowel cleanliness in traditional air-insufflation (AI) colonoscopy. Despite advances, split-dose preparation has limitations. What are these limitations and how have they been addressed