Loop Electrosurgical Excision Procedure
(LEEP)

What Is the medical definition of LEEP?

• Loop electrosurgical excision procedure (LEEP) is a technique used in the treatment of mild to moderate precancerous changes (dysplasia) of the uterine cervix (cervical dysplasia). The cervix is the base of the womb (uterus) that leads out to the birth canal (vagina).
• LEEP can sometimes also be used to treat severe dysplasia or cancers that have not invaded into the deeper tissues of the cervix (known as carcinoma in situ).
• With the LEEP technique, a low voltage electric current is used to cut away the abnormal tissues. Unlike techniques that destroy the abnormal tissue (such as laser or freezing), the abnormal tissue is preserved after LEEP, allowing for microscopic examination by a pathologist.

Is the LEEP procedure painful?

• LEEP generally does not have significant risks or side effects, but mild pain, cramping, and vaginal bleeding can occur. LEEP is also sometimes referred to as large loop excision of the transformation zone (LLETZ).

LEEP is performed after the precancerous changes of the cervix have been identified through screening tests and cervical biopsies. Typically, findings on the screening Pap test will signal that further examination of the cervix is necessary. Colposcopy is the examination of the vulva, vaginal walls, and uterine cervix using illumination and magnification in order to detect and examine abnormalities of these structures. Colposcopy is performed to evaluate abnormal Pap test results. During colposcopy, further testing, including biopsies (sampling of abnormal-appearing areas for examination by a pathologist) are performed to determine whether cancer or precancerous changes are present.

If dysplasia confirmed through colposcopy and/or biopsies, treatment options, including LEEP, are considered.

LEEP can be performed in a doctor's office or clinic or in a hospital outpatient surgery department. The patient lies on her back on an examining table with the feet supported in stirrups (the position used to obtain a Pap smear). The doctor will use a speculum to open the vaginal walls, again similar to the procedure for a Pap test. Local anesthetic medication is typically injected in the area of the cervix (known as a cervical block). Sometimes, medications for pain control are also given intravenously or taken pre-operatively in pill form.

After the cervix is visualized, special solutions may be applied to the outside surface of the cervix to make the abnormal areas of tissue more recognizable. To remove the abnormal tissues, a low-voltage electrical current is delivered via a thin wire that is passed through tissues. To be certain that all abnormal tissue is removed, a very thin layer of normal-appearing tissue surrounding the area is excised. The area is treated afterwards with a chemical substance to help prevent bleeding.

The most common side effects of the procedure are mild pain and cramping that may occur over the first few hours after the procedure. Spotting and vaginal discharge may occur and persist for up to several weeks. Sexual intercourse and tampon use should be avoided for a time to allow better healing. Douching should also be avoided.

The removed tissue will then be sent to the laboratory for microscopic analysis by a pathologist to determine if the abnormal areas were completely removed. This analysis may take several days to complete.

Complications are not common following LEEP. These may include increased bleeding, infection, or narrowing (stenosis) of the opening of the cervix. LEEP has been associated with preterm labor in a subsequent pregnancy and may require careful follow-up.

If the abnormal areas have been completely removed, no further treatment is usually necessary. However, since dysplasia can recur at a later time, regular follow-up Pap tests are required following LEEP to evaluate for possible recurrence.

LEEP has shown to be as effective as other methods (laser, cryocautery, cone biopsy) for treatment of cervical dysplasia. Studies have shown that all of these methods have a 93% 5-year survival rate for precancerous lesions of the uterine cervix.