Loop electrical excision procedure: Difference between revisions

Revision as of 03:28, 10 November 2023

Revision as of 03:32, 10 November 2023

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The '''loop electrosurgical excision procedure''' ('''LEEP''') is one of the most commonly used approaches to treat high grade [[cervical dysplasia]] (CIN II/III, HGSIL) discovered on [[colposcopy|colposcopic]] examination. In the UK, it is known as '''large loop excision of the transformation zone''' ('''LLETZ'''). It is considered a type of [[Cervical conization|conization.]] <ref>{{Cite journal |date=2022-12-22 |title=Loop Electrosurgical Excision Procedure (LEEP): Pre-Procedure, Technique, Post-Procedure |url=https://emedicine.medscape.com/article/1998067-overview?form=fpf}}</ref>

LEEP has many advantages including low cost and a high success rate.<ref>{{cite web |url=http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes |title=Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes |access-date=2016-11-27}}</ref> The procedure can be done in an office setting and usually only requires a [[local [[anesthesia|anesthetic]], though sometimes IV sedation or a general [[anesthesia|general anesthetic]] is used.<ref>{{cite web |url=http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |title=Advantages of LEEP |access-date=2007-12-28 |last=Mayeaux |first=E.J. Jr.|url-status=dead |archive-url=https://web.archive.org/web/20060904092302/http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |archive-date=2006-09-04 }}</ref> Disadvantages include reports of decreased sexual satisfaction <ref name=":0" /> and potential for preterm labor, though a meta-analysis suggested that in patients with existing CIN lesions as opposed to controls, the risk is not more than their baseline risk. <ref name="pmid24785601" />

==Process==

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However a large [[meta-analysis]] concluded that women with CIN have a higher baseline risk for preterm birth than the general population and that LEEP as the treatment for CIN probably increase this risk further. Also, the risk of preterm birth appears to increase with multiple treatments and increasing amounts of tissue removed.<ref name="pmid29095502">{{cite journal | vauthors = Kyrgiou M, Athanasiou A, Kalliala IE, Paraskevaidi M, Mitra A, Martin-Hirsch PP, Arbyn M, Bennett P, Paraskevaidis E | title = Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD012847 | date = November 2017 | pmid = 29095502 | pmc = 6486192 | doi = 10.1002/14651858.CD012847 }}</ref>

A study found that women reported a statistically significant decrease in sexual satisfaction following LEEP.<ref name=":0">{{cite journal|title=Sexual function after loop electrosurgical excision procedure for cervical dysplasia|first1=Namfon|last1=Inna|first2=Yupin|last2=Phianmongkhol|first3=Kittipat|last3=Charoenkwan|date=1 March 2010|journal=J Sex Med|volume=7|issue=3|pages=1291–1297|doi=10.1111/j.1743-6109.2009.01633.x|pmid=19968775}}</ref>

A [[systematic review]] and meta-analysis published in 2014 which sought to examine the differences in preterm labor risk between patients who had a LEEP procedure and those who had CIN findings concluded that there is not a significant difference between those groups in terms of risk, as might previously have been suggested. The study determined that both groups have a higher likelihood for preterm labor than healthy controls, but suggests that a LEEP procedure in a CIN patient might not carry as significant of an increase in risk for preterm labor in future pregnancies as is generally understood.<ref name="pmid24785601">{{cite journal | vauthors = Conner SN, Frey HA, Cahill AG, Macones GA, Colditz GA, Tuuli MG | title = Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis | journal = Obstetrics and Gynecology | volume = 123 | issue = 4 | pages = 752–61 | date = April 2014 | pmid = 24785601 | pmc = 4113318 | doi = 10.1097/AOG.0000000000000174 }}</ref> This perspective carries significant implications when it comes to pregnancy timing and decision making in women of child bearing age who have cervical dysplasia and would like to decide whether they should have the lesions removed before or after pregnancy. As pregnancy is generally understood to be an immune suppressed state, the viral mediated character of cervical lesions might also inform revisions to treatment recommendations in such instances.<ref name="pmid24785601"/>