What is a Loop Electrosurgical Excision Procedure (LEEP)?

From the Guidelines

LEEP (Loop Electrosurgical Excision Procedure) is a medical procedure used to remove abnormal tissue from the cervix, involving a thin wire loop heated by electrical current to cut away and remove the abnormal cells, as described in the 2019 guidelines by the National Comprehensive Cancer Network 1.

Procedure Overview

This procedure is typically performed when a Pap smear or colposcopy reveals precancerous cells on the cervix. LEEP is usually done in a doctor's office or clinic under local anesthesia and takes about 10-20 minutes to complete.

• The procedure involves the insertion of a speculum to view the cervix.
• A solution is applied to highlight abnormal areas.
• A numbing medication is injected.
• The electrified wire loop is then used to remove the tissue.

Post-Procedure Care

Patients may experience mild cramping, light bleeding, or discharge for a few weeks afterward.

• Most women can return to normal activities within 1-3 days.
• However, they should avoid sexual intercourse, tampons, and douching for about 4 weeks to allow proper healing.

Effectiveness and Risks

LEEP is highly effective at removing precancerous cells while preserving cervical function, though there is a small risk of complications such as bleeding, infection, or cervical stenosis, as noted in a study published in the Annals of Internal Medicine 1.

• The 2019 guidelines from the National Comprehensive Cancer Network suggest that LEEP is an acceptable approach for treating cervical intraepithelial neoplasia, as long as adequate margins, proper orientation, and a non-fragmented specimen without electrosurgical artifact can be obtained 1.
• Another study published in the American Journal of Obstetrics and Gynecology in 2007 also discusses the use of LEEP for treating CIN lesions, highlighting its effectiveness as an excisional method that provides a tissue specimen for pathological examination 1.

From the Research

Definition of LEEP

• LEEP stands for Loop Electrosurgical Excision Procedure, a method used for conization of the uterine cervix to diagnose cervical intraepithelial neoplasia (CIN) or cervical cancer 2.
• The procedure involves using a loop electrode to remove a cone-shaped tissue from the cervix, which can then be examined histologically 2.

Procedure and Outcomes

• LEEP is a simple and quick procedure that can be done at the first visit without major complications 2.
• The procedure can be performed with local anesthesia on an outpatient basis, resulting in less blood loss and operating time compared to other conization techniques such as cold knife conization and laser conization 3.
• LEEP has been shown to be effective in treating adenocarcinoma in situ (ACIS) of the cervix, with similar rates of negative margins, diagnosis of invasive cancer, and recurrence of ACIS or invasive cancer compared to cold knife conization 4.

Pain Management

• Pain management during LEEP can be achieved through various methods, including paracervical block (PB) and lidocaine spray (LS) 5.
• A study comparing LS and PB found that LS resulted in similar pain scores during excision and fewer adverse effects compared to PB 5.

Comparison with Other Techniques

• LEEP has been compared to other conization techniques, including cold knife conization and laser conization, in terms of treatment reliability, effectiveness, and safety 3.
• While LEEP is technically easier and less time-consuming, it may induce electrocautery artifact, making evaluation of the margins difficult in some cases 3.