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ABSTRACT & COMMENTARY
Synopsis: Loop electrosurgery can be used successfully to treat cervical stenosis.
Source: Curtis MG. J Gynecol Surg 1996;12:201.
This short article presents a series of five cases of significant cervical stenosis treated by loop electrosurgical excision procedure (LEEP). In all five cases, it was impossible to pass a small cervical dilator or cotton-tipped swab through the external os before therapy. All five women required endometrial biopsy for diagnostic reasons.
In each of these cases, loop electrosurgery was performed in the standard fashion. An endometrial sample was obtained successfully in all five at the end of the procedure. Two of the five women eventually required vaginal hysterectomy for benign indications not related to stenosis. The other three patients have been followed for at least three years, and cervical stenosis has not recurred.
The author suggests that loop electrosurgery might be as effective as other methods of releasing cervical stenosis (CO2 laser, dilation, etc.). The procedure can be performed easily in the office at reasonable cost.
COMMENT BY KENNETH L. NOLLER, MD
It occurred to me some time ago that loop electrosurgery might be an excellent way to release cervical stenosis. However, I have had excellent results using CO2 laser, and, since there is one present in my clinic, I have found no reason to change from this modality. CO2 laser results in long-term patency in most cases. However, most office suites do no have the luxury of a CO2 laser; thus, the use of electrosurgery would be more convenient, available, and less expensive. Although this series is very small, the three-year follow-up on three of the cases suggests that it is effective.
Cervical stenosis comes in at least two forms. Most commonly, only the cervical epithelium--or, at most, the epithelium plus 2-3 mm of stroma--covers the canal. In these cases, dilation, laser, loop electroexcision, or almost any other method you can think of, allows access to the endometrial cavity with ease. Unfortunately, some women, for whatever reason, stenose virtually the entire length of the cervical canal, making any form of therapy extremely difficult. I doubt the second form could be treated with loop electrosurgery in the office with ease. For these unfortunate patients, dilation in the operating room with ultrasound guidance may be the only way to obtain an endometrial biopsy.