The loop electrosurgical excision procedure (LEEP) is one of the most commonly used approaches to treat high grade
cervical dysplasia (
CIN II/III,
HGSIL) and early stage
cervical cancer
Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later sympt ...
discovered on
colposcopic examination. In the UK, it is known as large loop excision of the transformation zone (LLETZ). It is considered a type of
conization. It has been in use since the 1970s, after its invention by Dr. Sheldon Weinstein.
LEEP has many advantages including low cost and a high success rate. The procedure can be done in an office setting and usually only requires a
local anesthetic
A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...
, though sometimes IV sedation or a
general anesthetic
General anaesthetics (or anesthetics) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma that causes lack of aware ...
is used. Disadvantages include reports of decreased sexual satisfaction
and potential for
preterm labor, though a meta-analysis published in 2014 suggested that in patients with existing CIN lesions as opposed to controls, the risk is not more than their baseline risk.
Approximately 500,000 LEEP procedures are performed in the U.S. annually.
Process
When performing a LEEP, the
physician
A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
uses a wire loop through which an
electric current
An electric current is a flow of charged particles, such as electrons or ions, moving through an electrical conductor or space. It is defined as the net rate of flow of electric charge through a surface. The moving particles are called charge c ...
is passed at variable
power settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The
cervical transformation zone and
lesion
A lesion is any damage or abnormal change in the tissue of an organism, usually caused by injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals.
Types
There is no de ...
are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an
endocervical specimen for further
histologic evaluation.
The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with
pathological interpretation provided depth is not exceeded. The thermal artifact can be a function of depth and time.
Complications
Complications are less frequent in comparison to a
cold-knife conization but can include
infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...
and
hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...
.
LEEP effectively reduces the risk of cancer developing or spreading but it causes an increased risk of
premature birth
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...
in future pregnancies.
Following LEEP there is a 10% chance of cancer recurrence and 11% chance of preterm birth.
This perspective carries significant implications when it comes to pregnancy timing and decision making in women of child bearing age who have cervical dysplasia and would like to decide whether they should have the lesions removed before or after pregnancy. As pregnancy is generally understood to be an immune suppressed state, the viral mediated character of cervical lesions might also inform revisions to treatment recommendations in such instances.
Some women report a small decrease in sexual arousal and satisfaction following LEEP but there is a lack of high quality research showing how LEEP affects sexual function.
See also
*
Cervicectomy
References
{{DEFAULTSORT:Loop Electrical Excision Procedure
Female genital procedures
Surgical oncology
Cervical cancer