Colonic Explosion During Argon Plasma Coagulation: A Systematic Review of Risk Factors, Prevention, and Management
Fariha Hasan, Ayesha Liaquat, Ishan Bhalgat, Ahmer Khan, Hareesha Rishab Bharadwaj, Dushyant Singh Dahiya, Shahryar Khan, Christina Tofani, Apeksha Shah, Anthony InfantolinoABSTRACT
Introduction
Argon plasma coagulation (APC) is a non‐contact electrocoagulation technique widely used for hemostasis in gastrointestinal endoscopy. Despite its safety, rare but catastrophic complications such as colonic explosions have been reported. This systematic review aimed to synthesize available evidence on APC‐associated colonic explosions, identify risk factors, and highlight preventive and management strategies.
Methods
Following PRISMA guidelines, PubMed, Embase, Web of Science, and Cochrane CENTRAL were searched through August 2025 for studies reporting colonic explosions during APC. Eligible studies included clinical reports describing APC use in gastrointestinal procedures with outcomes of explosion or perforation. Data were extracted on patient demographics, procedural context, bowel preparation, and clinical outcomes.
Results
Ten studies, comprising 12 cases, were included. Explosions most frequently occurred during APC for radiation proctitis, adenoma, or angiodysplasia, predominantly after inadequate bowel preparation or use of enemas alone. Combustible gases—chiefly hydrogen and methane—were identified as the principal mediators. Perforation occurred in half of the cases, all of which were surgically repaired, with no reported fatalities.
Conclusion
Although rare, colonic explosion during APC remains a preventable event. Complete bowel cleansing with oral polyethylene glycol‐based agents, avoidance of air insufflation, and adherence to safety protocols are essential to minimize risk. Standardized preparation guidelines and further research are warranted.