LEEP

Loop electrosurgical excision procedure, commonly abbreviated as LEEP, is a gynecologic procedure used to remove abnormal tissue from the cervix, usually in response to abnormal cervical screening results such as a Pap test or HPV test. The goal is to excise precancerous cells arising from cervical intraepithelial neoplasia (CIN) while preserving as much healthy tissue as possible.

During the procedure, a thin, circular wire loop is energized with electric current to cut and coagulate tissue as it is advanced around the transformation zone of the cervix. The result is a cone-shaped specimen that is sent to pathology to determine the grade of CIN. LEEP is commonly performed in an outpatient setting, often with local anesthesia; sedation or general anesthesia may be used depending on the patient and local practice.

Indications and effectiveness: It is used for CIN 2/3 and HSIL, and can also be used to diagnose uncertain lesions. It has high cure rates and allows rapid tissue diagnosis. It preserves cervical anatomy better than some alternatives, though it slightly reduces cervical length, which may affect future pregnancies.

Recovery and risks: Most women experience mild cramping and light vaginal bleeding for a few days. They are usually advised to avoid intercourse, vaginal products, and heavy lifting for several weeks. Potential risks include bleeding, infection, cervical stenosis or scarring, and, in rare cases, injury to surrounding tissue. There is an associated small increased risk of preterm birth in future pregnancies.

Alternatives and related terms: Cold knife conization, cryotherapy, laser ablation, or active surveillance for selected low-grade lesions. In many countries, the term LLETZ (large loop excision of the transformation zone) is used interchangeably with LEEP at times.