What does LEEP (Loop Electrosurgical Excision Procedure) stand for?

LEEP: Definition and Clinical Application

LEEP stands for Loop Electrosurgical Excision Procedure, a technique used for diagnosis and treatment of cervical dysplastic lesions. 1

Definition and Terminology

• LEEP is also known by several other names including:
  • Loop diathermy treatment 1
  • Loop Excision of the Transformation Zone (LETZ) 1
  • Large Loop Excision of the Transformation Zone (LLETZ) 1

Technical Aspects

• LEEP uses low-current, high-frequency electrical generators and thin stainless steel or tungsten loops to excise either specific lesions or the entire transformation zone of the cervix 1
• The procedure produces cone-shaped tissue specimens that can be examined histologically, providing material for definitive diagnosis 2
• LEEP can be performed as an outpatient procedure, typically in a clinician's office setting 1, 3

Clinical Applications

• LEEP is primarily used for:
  • Diagnosis and treatment of cervical intraepithelial neoplasia (CIN) 2
  • Management of high-grade squamous intraepithelial lesions (HSIL) 4
  • Evaluation of abnormal cervical cytology when colposcopy is unsatisfactory 5
  • Treatment of persistent low-grade squamous intraepithelial lesions (LSIL) 6

Advantages Over Other Methods

• LEEP provides tissue specimens for histological evaluation, unlike ablative procedures such as cryotherapy 5, 1
• The procedure can be performed under local anesthesia with minimal discomfort 2
• LEEP is cost-effective compared to hospital-based procedures ($700 vs. $1450) 3
• It requires fewer patient visits compared to other treatment methods 1
• The technique is relatively easy to learn and implement in a family practice setting 1, 3

Limitations and Considerations

• LEEP may be associated with tissue fragmentation (45.2% vs. 8.5% with cold knife conization) 4
• There are concerns about interpretability of resection margins in some cases 4
• Women of reproductive age should be counseled about potential increased risks of preterm birth before undergoing LEEP 6, 7
• For adolescents and young women, observation rather than immediate treatment is often recommended due to high regression rates of cervical lesions 6

When to Use LEEP vs. Other Methods

• LEEP is preferred over ablative methods when:
  • Colposcopy is unsatisfactory (cannot visualize the entire squamocolumnar junction) 6
  • Endocervical sampling shows dysplasia 6
  • There is persistent or recurrent LSIL after previous ablative therapy 6
  • The lesion is preceded by HSIL or AGC-NOS cytology 6
• Cold knife conization may be preferred when:
  • There is concern for adenocarcinoma in situ (AIS) 5
  • More precise margins are required for pathological evaluation 4

LEEP has become an important tool in the management of cervical dysplasia, offering a balance between diagnostic accuracy and treatment efficacy while minimizing patient discomfort and healthcare costs 1, 3.