Loop electrosurgical excision procedure (LEEP)

A loop electrosurgical excision procedure (LEEP) uses a loop of thin wire to remove abnormal tissue from the cervix. This may include tissue with precancerous cells (called cervical dysplasia) or cancerous cells. The loop is heated using electricity to remove the tissue. LEEP may also be called a loop excision or large loop excision of the transformation zone (LLETZ).

LEEP may be done to:

• diagnose precancerous conditions of the cervix and cervical cancer
• treat precancerous conditions of the cervix and early-stage cervical cancer

A LEEP usually takes about 15 minutes. Your healthcare team will tell you what to expect before the procedure, but you don't need to prepare for it. It may be done in your doctor's office, at a colposcopy clinic or at a hospital.

During the procedure, you will be in the same position as you are for a Pap test – lying on your back with your feet up in stirrups. The doctor will place a speculum( the same instrument used during a Pap test) into the vagina to be able to see the cervix. Freezing ( local anesthetic) will be used to numb the cervix.

The doctor will look through a magnifying microscope (colposcope) to see the cervix. The doctor uses the loop to remove the abnormal cells and then seals the cervix to prevent bleeding. During the procedure, the equipment connected to the loop may make loud noises.

An endocervical curettage may be done at the same time as a LEEP. This procedure uses a narrow tool called a curette to remove a sample of cells from the cervical canal above the area where the LEEP was done.

The tissue samples are then sent to a lab to look for precancerous or cancerous cells.

After a LEEP, most people can return to their normal activities the same day. To reduce the risk of bleeding and infection, avoid the following:

• exercise and heavy lifting (such as running or doing yard work) for 2 weeks

• sexual intercourse for 4 weeks
• using tampons or a menstrual cup for 4 weeks

If there are still high-grade abnormal cells present after the first procedure, a LEEP may need to be done again. After the LEEP is done, you will have a follow-up appointment that will include a colposcopy or a Pap test every 3 to 6 months. After 2 to 3 follow-up visits, your healthcare team will decide when you should have your next test.

As with any procedure, side effects can occur after LEEP. Tell your healthcare team if you have side effects that you think are from LEEP. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects may include:

• menstrual-like cramps
• dark brown discharge from the vagina
• spotting (small amounts of blood) from the vagina

Less common but more serious side effects include:

• heavy bleeding from the vagina
• pain that doesn’t go away with pain medicine
• signs of infection such as increasing pain, fever and discharge from the vagina that is yellowish and smells bad

Longer-term side effects after having a LEEP may include:

• cervical stenosis (narrowing of the cervix) that can lead to painful periods and make it harder to get pregnant

• premature labour (earlier delivery) if you get pregnant in the future

The pathology lab will check the sample for abnormal cells. Your doctor will give you a pathology report based on what they found. The pathology report describes the types of cells in the sample and if they are precancerous or cancerous.

Your doctor may recommend more tests, procedures, follow-up care or treatment. A LEEP often removes all the abnormal cells and no further treatment is needed.