Loop Electrosurgical Excision Procedure
(LEEP)

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Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr, MD, FACP, FACR

• What is LEEP?
• How is a LEEP done?
• How effective is LEEP?
• What are complications of LEEP?
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What is LEEP?

Loop electrosurgical excision procedure (LEEP), uses a low-voltage electrical current to remove abnormal tissues of the cervix. It has an advantage, therefore, over the destructive techniques (CO2 laser and cryocautery) in that an intact tissue sample for analysis can be obtained. LEEP also is popular because it is inexpensive, simple, and typically has few risks or side effects. LEEP is also known as large loop excision of the transformation zone (LLETZ).

This procedure is used most often for treating mild to moderate dysplasia (abnormal changes of the cells lining the cervix or precancers) that have been identified by colposcopy and/or cervical biopsy. In certain situations, severe dysplasia and noninvasive cancer that are localized and can be removed, may also be treated by LEEP.

How is a LEEP done?

The patient lies on an examining table with the feet elevated in stirrups (the position used to obtain a Pap smear). A speculum (as used for the Pap test) is inserted to open the vaginal walls. Sometimes a special solution, either vinegar (acetic acid) or iodine, is applied to the cervix prior to the procedure, which makes the abnormal areas of tissue more recognizable).

The area is numbed using a local anesthetic (cervical block). Oral or intravenous medications to control pain may also be given. A low-voltage electrical current is delivered via a thin wire that is passed through tissues to remove the abnormal areas of the cervix. A chemical is applied afterwards to prevent bleeding.

Mild pain and cramping that can be relieved by oral medications may occur for the first few hours following the procedure. Vaginal discharge and spotting commonly occur after this procedure for up to a few weeks. Sexual intercourse and tampons use should be avoided for several weeks to allow better healing. Douching should also be avoided.