Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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.
How effective is LEEP?
LEEP has been shown to be comparable to cryotherapy, cold knife conization (surgical removal of the abnormal area), laser ablation (destruction of the abnormal tissue), and laser conization for the removal of abnormal or precancerous tissues of the cervix. Studies have shown that
a majority of these methods result in a cure (removal of all the affected tissue).
Further treatment is not typically necessary if all of the abnormal area has been removed, although the precancerous changes may develop again (recur) at a later time. Regular follow-up Pap tests are required following LEEP to evaluate for possible recurrence of the cellular abnormalities.
What are complications of LEEP?
Complications occur in about a small percentage of women undergoing LEEP,
including narrowing (stenosis) of the opening of the cervix, greater than expected amounts of bleeding, or infection or the cervix or uterus.
Medically reviewed by Steven Nelson, MD; Board Certified Obstetrics and Gynecology
"Patient information: Management of a cervical biopsy with precancerous cells (Beyond the Basics)"