What is LEEP?

A LEEP (Loop Electrosurgical Excision Procedure) is one of the diagnostic excisional procedures for the removal of high-grade cervical dysplasia.1,2 A thin, loop-shaped wire attached to an electrosurgical generator is used to pass around and under the transformation zone, excising the abnormal portion of the cervix using thermal energy. The electrical current allows the loop tool to both cut and coagulate at the same time, although its use is followed by a ball electrode to complete the coagulation. The removed specimen is sent to a pathology laboratory for further analysis to help determine the extent of the lesion. In this way, LEEP is both a treatment and a diagnostic procedure. 

The procedure is often done at the doctor’s office and is brief, usually taking less than 30 minutes.1 It begins very similarly to a colposcopy, in which the patient is placed in lithotomy position, a speculum is placed, and a colposcope may be used to better visualize the cervix. Local anesthetic and a vasoconstrictive solution are administered to minimize discomfort and bleeding. Application of local anesthetic is often associated with an initial burning sensation that fades as the anesthetic begins to work.  

Following a LEEP, patients may experience some lower abdominal and pelvic pain and may have bloody vaginal discharge for 7-10 days followed by yellowish discharge for up to a month.1 Fever, foul-smelling discharge, heavy vaginal bleeding (>1 pad in an hour or passing clots) are not expected and should prompt evaluation.  

Patients should avoid intercourse, placing anything in the vagina, or immersing in water for 2-4 weeks. Patients are typically scheduled for a follow-up visit a few weeks after the procedure to ensure appropriate healing and to review histopathological results. The final pathology report is used to determine appropriate follow-up.

References

1. WHO Guidelines Approved by the Guidelines Review Committee. Comprehensive Cervical Cancer Control: A Guide to Essential Practice. World Health Organization, Copyright © World Health Organization 2014.; 2014. 

2. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. Apr 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525