What is the LEEP (Loop Electrosurgical Excision Procedure) procedure for treating cervical dysplasia?

Loop Electrosurgical Excision Procedure (LEEP) for Cervical Dysplasia

LEEP is the preferred treatment for cervical dysplasia, particularly for high-grade lesions (CIN-2/3), as it provides effective treatment with minimal complications while preserving fertility. 1, 2

What is LEEP?

LEEP is a surgical procedure that uses a thin wire loop electrode with an electrical current to remove abnormal cervical tissue. The procedure:

• Removes the transformation zone of the cervix where dysplasia typically develops
• Provides a tissue specimen for histological examination
• Can be performed as an outpatient procedure
• Usually requires minimal or no anesthesia
• Takes approximately 5-10 minutes to complete

Indications for LEEP

LEEP is indicated for:

• High-grade cervical dysplasia (CIN-2/3)
• Persistent low-grade dysplasia (CIN-1) after observation
• Unsatisfactory colposcopy with high-grade cytology
• Discrepancy between cytology and biopsy results
• Recurrent abnormal cytology after previous treatment

Advantages of LEEP

• Provides tissue for histological examination (unlike ablative procedures)
• High success rate (85-95% cure rate) 3
• Low complication rate (approximately 5%) 3
• Preserves fertility
• Can be performed in an outpatient setting
• Quick procedure with minimal discomfort

Procedure Details

1. Patient positioning in lithotomy position
2. Colposcopic examination to identify the lesion
3. Application of acetic acid and/or Lugol's iodine to highlight abnormal areas
4. Local anesthesia injection (if needed)
5. Selection of appropriate loop size based on lesion
6. Removal of the transformation zone with the loop electrode
7. Hemostasis achieved with ball electrode cautery
8. Specimen sent for pathological examination

Alternative Treatment Options

While LEEP is preferred for most cases, other options include:

• Cryotherapy or laser ablation (acceptable for CIN-1 and some CIN-2/3 with satisfactory colposcopy) 1
• Cold knife conization (preferred when microinvasive cancer is suspected or for obtaining better margins) 1, 2
• Hysterectomy (only for CIN-3 with other indications for hysterectomy, not as primary therapy) 1

Follow-up After LEEP

Proper follow-up is essential:

• Cytology at 6 months or HPV DNA testing at 12 months 1
• Refer to colposcopy if repeat cytology shows ASC-US or greater, or if HPV positive 1
• After two consecutive negative cytology results or a negative HPV test, return to annual screening 1
• Long-term surveillance is important as recurrence can occur years after treatment 2

Predictors of Recurrence After LEEP

Several factors increase the risk of recurrent dysplasia:

• Positive surgical margins (39% vs. 15% with negative margins) 4
• Involvement of endocervical glands (33% vs. 14% without involvement) 4
• Multiple quadrant involvement (33% vs. 14% with single quadrant) 4
• Persistent HPV infection after treatment 5
• Higher grade lesions (CIN-3 has higher recurrence risk) 5

Special Considerations

Pregnancy

• LEEP should be avoided during pregnancy due to risks of bleeding and preterm birth 1
• Observation is recommended with treatment delayed until after pregnancy 2

Unsatisfactory Colposcopy

• Diagnostic excisional procedures are recommended for unsatisfactory colposcopy with high-grade cytology 1
• LEEP or cold knife conization can be used in this setting 1

Immunosuppressed Patients

• Higher risk of recurrence/persistence
• More intensive follow-up may be needed

Complications

• Bleeding (most common, usually minor)
• Infection (rare)
• Cervical stenosis (uncommon)
• Potential impact on fertility and pregnancy outcomes (slight increase in preterm birth risk)

LEEP has proven to be a safe, effective, and fertility-preserving treatment for cervical dysplasia with high success rates and low complication rates. Proper patient selection, technique, and follow-up are essential for optimal outcomes.