Please note that these referrals are managed by EHHOP Gynecology Clinic.
If you are in Main Clinic and a patient receives an abnormal Pap result, please refer the patient to EHHOP GYN.
Indications for LEEP
A LEEP, aka loop excision electrocautery procedure, is a procedure that removes precancerous cells from the cervix in order to prevent their progression to cancer or their invasion into surrounding tissues. Need for a LEEP is most often determined following an abnormal Pap smear and subsequent colposcopy which reveal concern for a precancerous lesion on the cervix. Colposcopy can be performed in EHHOP Gyn and should be scheduled and coordinated with the EHHOP Gyn Chief TS.
Pap smear histology is graded on a scale of negative, ASC-US, LSIL and HSIL. Colposcopy findings are graded on a scale of benign, CIN 1, CIN 2, and CIN 3. The CIN grades, particularly 2 and 3, may indicate an excisional procedure such as LEEP.
Please see the corresponding sections for the respective CIN grades.
CIN 1
The patient should be seen at EHHOP GYN by Dr. Nentin for counseling.
CIN 1 is managed conservatively by many attendings, so these patients should be seen in EHHOP GYN or by an E-Level attending for counseling. It is not appropriate to schedule these patients for LEEP before they are counseled as management may vary patient by patient.
CIN 2 or CIN 3
The patient should be seen and counseled by a gyn attending who performs LEEPs about the risks, benefits, alternatives of a diagnostic excisional procedure. Surveillance is an option for a subset of patients and they should be counseled appropriately on what that entails.
If patient and provider decide to move forward with a LEEP, email obgynclinic-appointments@mountsinai.org and request next available LEEP appointment. CC Farida Nentin on the email, because the schedulers will need approval to book into these slots. Normally they’re only booked in person from colpo clinic.
Patient should be assessed for medical or physical indications (bleeding disorders, difficult to visualize cervix, etc) that suggest the patient may be a better candidate to have her LEEP in the operating room.
Patients should be assessed for cervical indications that she may be a better candidate for a Cold-knife Cone Biopsy in the operating room (History of 2+ LEEPs, repetitive positive margins, cervical adenocarcinoma in situ, microinvasion, future pregnancy desires)
Draw CBC and T&S at EHHOP 1-2 weeks before procedure.
Counsel patients regarding being NPO after midnight the night before the procedure, except water and meds
LEEPs are scheduled for 8:30am. Patients are expected to arrive at 8:15am at the latest. Patients who arrive late may not be able to be accommodated: these are sometimes lengthy procedures that are scheduled at the beginning of a busy colpo panel.
The EHHOP GYN Chief Teaching Senior (see EHHOP Roster) will review the chart and forward to the appropriate attending who’s performing the LEEP on that scheduled date. They will review and be in contact if any issues.
Cost
Every patient that needs a LEEP, should be scheduled for a LEEP, regardless of their ability to pay or insurance status. Appointments can be scheduled even without CC/EMC. The patient’s ability to pay the ten-dollar co-pay will not impede their ability to undergo the procedure.
Remember that these are pre-malignancy diagnoses: please do not delay a LEEP scheduling for financial reasons alone.
Wait Time
Waiting time is usually approximately one month, with some flexibility based on urgency and time needed to arrange for REAP or EMC.
Contact Information
OB/Gyn Clinic Appointments: obgynclinic-appointments@mountsinai.org
For questions, please reach out to the GYN Chief Teaching Senior and/or the ACT Referrals Chair (see EHHOP Roster).