Loop Electrosurgical Excision Procedure (LEEP)

Overview

What is a LEEP (loop electrosurgical excision procedure)?

LEEP is an abbreviation for loop electrosurgical excision procedure. It is a way to test and treat abnormal cell growth on the surface tissue of the cervix. LEEP may be recommended after abnormal changes in the cervix are confirmed by Pap tests and colposcopy biopsies. Colposcopy is a non-invasive procedure in which a device similar to a microscope is used to view the cervix. LEEP allows your physician to remove the abnormal tissue and test it for cancer.

Frontal view of cervix - The electrosurgical loop removes a thin layer of surface cells from the cervix

Abnormal cell growth on the surface of the cervix is called cervical dysplasia. Though cervical dysplasia is not cancer, over time it can worsen and lead to cancer if left untreated.

Procedure Details

How is LEEP (loop electrosurgical excision procedure) performed?

LEEP begins much like a regular pelvic exam. Though you will remain awake throughout the procedure, you should feel only minor discomfort. First, you will be asked to lie back and rest your feet in stirrups at the end of the examination table. A speculum will be inserted into the vagina and opened so that the cervix can be seen.

LEEP

Positioning for loop electrosurgical excision procedure

A very dilute solution of acetic acid or Lugol’s solution (Iodine) is applied to the cervix to make the abnormal cells visible. Your physician then places a colposcope near the opening of the vagina. The colposcope, which remains outside of the vagina, provides a magnified view of the cervix.

The cervix is then numbed with local anesthesia. This may cause tingling in the tongue, ringing in your ears or a rapid heart rate. If this occurs, it lasts for only a few minutes. Once the cervix is numb, an electrically charged loop made of thin wire is inserted through the speculum and up to the cervix.

As the loop is passed across the cervix, it cuts away a thin layer of surface tissue, removing the abnormal cells. Sometimes a second loop is used to go a little higher up the cervix. This tissue will be later tested for cancer or abnormal cells as well as proximity of the abnormal cells to the edge of the tissue that was removed (the margins).

Finally, a medicated paste (an iron solution called Monsel’s paste) is applied to the area to stop and prevent bleeding.

How long does the procedure take?

The procedure takes 10 to 20 minutes to perform. You will be able to go home as soon as the procedure has been completed.

Risks / Benefits

Is LEEP (loop electrosurgical excision procedure) safe?

Yes. LEEP is very safe. Complications are rare and the procedure can be completed without use of general anesthesia. However, there are some risks, such as infection and bleeding. Also, if a large area needs to be removed, or if there is need for multiple LEEP procedures, a doctor will check your cervix by ultrasound during any subsequent pregnancies. Sometimes the cervix is weakened by these procedures, leading to early delivery of a baby. Discuss any concerns you may have with your doctor.

Recovery and Outlook

What can I expect when recovering at home after LEEP (loop electrosurgical excision procedure)?

  • Vaginal drainage or spotting is normal for one to three weeks following the procedure. The medication paste will produce a greenish-yellow discharge immediately after the procedure which may have a mild odor. A brownish-black vaginal discharge is also normal.
  • Pads may be used for discharge. You should avoid placing anything in the vagina for four weeks, including tampons.
  • Your menstrual cycle will not be disrupted by this procedure.
  • Avoid excessive activity for 48 hours after the procedure. Refrain from exercising for at least one week. You can begin exercising again in one to two weeks. Stop exercising if bleeding other than normal menstruation occurs. If excessive bleeding occurs after you resume normal activities, call your physician.
  • Abstain from sexual intercourse for four weeks.
  • Showers are allowed.

How do I relieve discomfort after LEEP (loop electrosurgical excision procedure)?

During your recovery, you may experience vaginal bleeding and mild cramping. To relieve abdominal cramping, take a non-aspirin, over-the-counter pain reliever such as ibuprofen (Motrin®, Advil®) or acetaminophen (Tylenol®).

When to Call the Doctor

When should I contact my physician during recovery from LEEP (loop electrosurgical excision procedure)?

Contact your physician if you experience any of the following symptoms during your recovery:

  • Heavy bleeding (more than a normal menstrual flow)
  • Bleeding with clots
  • Vaginal discharge that has an increasingly foul odor
  • Fever over 100.4 degrees Fahrenheit
  • Severe abdominal pain

Additional Details

Are there other treatments for cervical dysplasia other than LEEP (loop electrosurgical excision procedure)?

Yes. There are a number of ways your physician can remove abnormal tissue from the cervix. These methods include:

  • Cryosurgery: The surface tissue is destroyed by freezing, but this does not allow for pathologic review of the tissue to look for cancer.
  • Cold knife conization: Removal of a cone-shaped wedge of tissue from the cervix which carries similar risks to LEEP and allows for pathology to assess the tissue for cancer.
  • Laser treatment or cone excision: Heat from a high-intensity beam of light is used to destroy or cut away abnormal tissue. The downfall of this procedure is that there is no specimen for the pathologist to review to look for cancer cells.

The treatment that is best for you will depend on factors such as the amount and location of the abnormal tissue.

Last reviewed by a Cleveland Clinic medical professional on 03/04/2019.

References

  • The American College of Obstetricians and Gynecologists. . Accessed 3/7/2019. LOOP Electrosurgical Procedure (LEEP) (https://www.acog.org/Patients/FAQs/Loop-Electrosurgical-Excision-Procedure-LEEP)
  • American Cancer Society. . Accessed 3/7/2019. Tests for Cervical Cancer (https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/how-diagnosed.html)
  • Merck Manual Consumer Version. . Accessed 3/7/2019.Tests for Gynecologic Disorders (https://www.merckmanuals.com/home/women-s-health-issues/diagnosis-of-gynecologic-disorders/tests-for-gynecologic-disorders)
  • Planned Parenthood. Accessed 3/7/2019.What’s LEEP? (https://www.plannedparenthood.org/learn/cancer/cervical-cancer/whats-leep)

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