Loop electrical excision procedure: Difference between revisions

Revision as of 20:12, 16 November 2023

Revision as of 17:29, 3 December 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]] ([[Cervical intraepithelial neoplasia|CIN]] II/III, [[High grade squamous intraepithelial lesion|HGSIL]]) and early stage [[cervical cancer]] 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> It has been in use since the 1970s, after its invention by Dr. Sheldon Weinstein. <ref>{{Cite web |title=Loop Electrosurgical Excision Procedure (LEEP) {{!}} Embryo Project Encyclopedia |url=https://embryo.asu.edu/pages/loop-electrosurgical-excision-procedure-leep |access-date=2023-11-16 |website=embryo.asu.edu}}</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 anesthetic]], though sometimes IV sedation or a [[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">{{cite journal |last1=Inna |first1=Namfon |last2=Phianmongkhol |first2=Yupin |last3=Charoenkwan |first3=Kittipat |date=1 March 2010 |title=Sexual function after loop electrosurgical excision procedure for cervical dysplasia |journal=J Sex Med |volume=7 |issue=3 |pages=1291–1297 |doi=10.1111/j.1743-6109.2009.01633.x |pmid=19968775}}</ref> and potential for [[preterm labor]], though a meta-analysis published in 2014 suggested that in patients with existing CIN lesions as opposed to controls, the risk is not more than their baseline risk.<ref name="pmid24785601">{{cite journal |vauthors=Conner SN, Frey HA, Cahill AG, Macones GA, Colditz GA, Tuuli MG |date=April 2014 |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 |doi=10.1097/AOG.0000000000000174 |pmc=4113318 |pmid=24785601}}</ref> Approximately 500,000 LEEP procedures are performed in the U.S. annually. <ref>{{Cite journal |lastlast1=Sklavos |firstfirst1=Martha M. |last2=Spracklen |first2=Cassandra N. |last3=Saftlas |first3=Audrey F. |last4=Pinto |first4=Ligia A. |date=2014 |title=Does Loop Electrosurgical Excision Procedure of the Uterine Cervix Affect Anti-Müllerian Hormone Levels? |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953513/ |journal=BioMed Research International |volume=2014 |pages=875438 |doi=10.1155/2014/875438 |issn=2314-6133 |pmc=3953513 |pmid=24707500 |doi-access=free }}</ref>

==Process==

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Complications are less frequent in comparison to a [[cervical conization|cold-knife conization]] but can include [[infection]] and [[hemorrhage]].<ref>{{Cite journal |last1=Jiang |first1=Yanming |last2=Chen |first2=Changxian |last3=Li |first3=Li |date=2017-01-26 |title=Comparison of Cold-Knife Conization versus Loop Electrosurgical Excision for Cervical Adenocarcinoma In Situ (ACIS): A Systematic Review and Meta-Analysis |journal=PLOS ONE |volume=12 |issue=1 |pages=e0170587 |doi=10.1371/journal.pone.0170587 |issn=1932-6203 |pmc=5268480 |pmid=28125627 |bibcode=2017PLoSO..1270587J |doi-access=free }}</ref>

LEEP effectively reduces the risk of cancer developing or spreading but it causes an increased risk of [[Preterm birth|premature birth]] in future pregnancies.<ref name=":1">{{Cite journal |lastlast1=Athanasiou |firstfirst1=Antonios |last2=Veroniki |first2=Areti Angeliki |last3=Efthimiou |first3=Orestis |last4=Kalliala |first4=Ilkka |last5=Naci |first5=Huseyin |last6=Bowden |first6=Sarah |last7=Paraskevaidi |first7=Maria |last8=Arbyn |first8=Marc |last9=Lyons |first9=Deirdre |last10=Martin-Hirsch |first10=Pierre |last11=Bennett |first11=Phillip |last12=Paraskevaidis |first12=Evangelos |last13=Salanti |first13=Georgia |last14=Kyrgiou |first14=Maria |date=2022-07-25 |title=Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S1470204522003345 |journal=The Lancet Oncology |language=en |volume=23 |issue=8 |pages=1097–1108 |doi=10.1016/S1470-2045(22)00334-5 |pmc=9630146 |pmid=35835138}}</ref><ref name=":2">{{Cite journal |date=2023-11-10 |title=Prevention of cervical cancer: what are the risks and benefits of different treatments? |url=https://evidence.nihr.ac.uk/alert/prevention-of-cervical-cancer-what-are-the-risks-and-benefits-of-different-treatments/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60599}}</ref><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 |date=November 2017 |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 |doi=10.1002/14651858.CD012847 |pmc=6486192 |pmid=29095502}}</ref> Following LEEP there is a 10% chance of cancer recurrence and 11% chance of preterm birth.<ref name=":1" /><ref name=":2" /> 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" />

Some women report a small decrease in sexual arousal and satisfaction following LEEP but there is a lack of high quality research showing how LEEP affects sexual function.<ref>{{Cite journal |lastlast1=Litman |firstfirst1=Ethan A. |last2=Cigna |first2=Sarah T. |date=2022-04-07 |title=Female Sexual Dysfunction in Women After Treatment of Cervical Dysplasia |url=https://linkinghub.elsevier.com/retrieve/pii/S2050052122000221 |journal=Sexual Medicine Reviews |language=en |volume=10 |issue=3 |pages=360–366 |doi=10.1016/j.sxmr.2022.02.003}}</ref>

==See also==