Loop electrosurgical excision procedure (LEEP)
A loop electrosurgical excision procedure (LEEP) uses an electric current passed through a loop of thin wire to remove abnormal tissue from the cervix. The loop of wire acts like a scalpel to remove the tissue. LEEP may also be called large loop excision of the transformation zone (LLETZ) or a loop excision.
Why LEEP is done
LEEP is one of the ways of doing a cone biopsy. LEEP may be done to:
- follow up on a consistently abnormal Pap test result
- diagnose precancerous changes
- diagnose invasive cervical cancer (cancer that is growing into surrounding tissue or has spread beyond the cervix)
- treat precancerous conditions of the cervix and carcinoma in situ in the cervix
How LEEP is done
You don’t need to do any special preparation before LEEP and it usually takes only a few minutes. It may be done in your doctor’s office, at a colposcopy clinic or at a hospital.
To begin, the doctor places a speculum (the same instrument used during a Pap test) into the vagina to keep it open. The doctor uses a local anesthetic (freezing) to numb the cervix. You may feel a slight sting followed by a bit of aching or cramping.
The doctor then uses a colposcope (a lighted magnifying instrument) to view the vagina and cervix and to guide the loop of wire to the tissue in the cervix. The doctor uses the wire loop to remove cervical tissue. When the procedure is finished, the doctor will put a special solution on the cervix or use heat to stop any bleeding (called electrocautery).
The doctor may do endocervical curettage at the same time as LEEP. This procedure uses a special tool, called a curette or a brush, to remove cells from the endocervical canal (the passageway from the uterus to the vagina).
Once the cervical tissue is removed, it is sent to a lab and examined under a microscope.
After LEEP, there is often some discharge from the vagina. This discharge can last for a few weeks, so your healthcare team will tell you to use sanitary pads. Don’t insert anything into the vagina, such as tampons or a vaginal douche, for 2–4 weeks after the procedure. You should also avoid having sexual intercourse for 2–4 weeks after the procedure. Report any unusual pain in the pelvis, heavy bleeding (with or without blood clots), severe abdominal pain or signs of infection (foul-smelling discharge or fever) to your doctor.
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.
Short-term side effects can happen during, immediately after or a few weeks after LEEP. They are usually temporary. Side effects may include:
- menstrual-like cramps
- dark-brown discharge
- bleeding or spotting
- narrowing, or stenosis, of the cervix, which in rare cases can cause painful periods
Long-term side effects can develop months or years after the procedure is done and can last a long time. Most women don’t have long-term side effects after LEEP. Recent studies suggest that LEEP probably doesn’t affect a woman’s fertility. Women who have had LEEP may deliver their babies a little earlier than women who have never had LEEP. If you become pregnant after having LEEP, be sure to tell your healthcare team so they can monitor your pregnancy and watch for signs of a possible early delivery.
What the results mean
A pathologist will examine the tissue removed during LEEP under a microscope. The pathologist’s report will tell your doctor if the cells of the cervix are normal, there is a precancerous condition of the cervix or there is cervical cancer.
What happens if the result is abnormal
Based on the pathology report, your doctor will decide if you need more tests, procedures or treatments.
Follow-up may include:
- Pap test
- HPV test
- endocervical curettage (a procedure that uses a special tool, called a curette or a brush, to remove cells from the endocervical canal, usually done at the same time as a colposcopy)