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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''').
LEEP has many advantages including low cost, 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 |
==Process==
When performing a LEEP, the [[physician]] uses a wire loop through which an [[electric current]] is passed at variable [[Power (physics)|power]] settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The [[cervix|cervical]] transformation zone and [[lesion]] are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an [[endocervical]] specimen for further [[histology|histologic]] evaluation.<ref>{{cite web |url=http://womenshealth.about.com/cs/surgery/a/leepprocedure.htm|title= LEEP Procedure — What is LEEP? — Loop Electrosurgical Excision Procedure|
The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with [[pathology|pathological]] interpretation.{{citation needed|date=September 2020}}
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A cohort study came to the result that women with a time interval from LEEP to pregnancy of less than 12 months compared with 12 months or more were at significantly increased risk for [[spontaneous abortion]], with risk of miscarriage of 18% compared with 4.6%, respectively.<ref name=Chescheir2013>{{Cite journal | last1 = Conner | first1 = S. N. | last2 = Cahill | first2 = A. G. | last3 = Tuuli | first3 = M. G. | last4 = Stamilio | first4 = D. M. | last5 = Odibo | first5 = A. O. | last6 = Roehl | first6 = K. A. | last7 = MacOnes | first7 = G. A. | doi = 10.1097/01.AOG.0000435454.31850.79 | title = Interval from Loop Electrosurgical Excision Procedure to Pregnancy and Pregnancy Outcomes | journal = Obstetrics & Gynecology | volume = 122 | issue = 6 | pages = 1154–9 | year = 2013 | pmid = 24201682| pmc = 3908542}}</ref> On the other hand, no increased risk was identified for [[preterm birth]] after LEEP.<ref name=Chescheir2013/>
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>{{cite journal | author = Kyrgiou M, Athanasiou A, Kalliala IEJ | display-authors = etal | year = 2017| title = Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease | journal = The Cochrane Database of Systematic Reviews | volume = 11
A study found that women reported a statistically significant decrease in sexual satisfaction following LEEP.<ref>{{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>
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