Name of the Procedure:

Endocervical Curettage (ECC)

Summary

Endocervical curettage is a medical procedure in which cells are scraped from the endocervical canal, the passage between the cervix and the uterus. This is done using a small, thin instrument called a curette to collect cells for examination under a microscope. It is typically performed to diagnose or rule out conditions such as cervical cancer or precancerous changes.

Purpose

Endocervical curettage is primarily used to detect abnormal cells in the endocervical canal that might indicate cervical cancer or pre-cancer. The goal is to identify and diagnose potential issues early so they can be treated promptly. It is often performed after an abnormal Pap smear or when symptoms suggest a problem within the cervical canal.

Indications

• Abnormal Pap smear results
• Postmenopausal bleeding
• Irregular or unexplained vaginal bleeding
• To further investigate abnormalities seen during a colposcopy
• Suspected cervical cancer or precancerous changes

Preparation

• Patients may be advised to avoid using tampons, douches, or vaginal medications 24-48 hours before the procedure.
• Fasting is generally not required.
• Inform the healthcare provider of any medications you are taking, as some might need to be adjusted.
• A pelvic exam and possibly other diagnostic tests, such as a Pap smear or colposcopy, might be performed beforehand.

Procedure Description

1. The patient will lie on an exam table with their feet in stirrups.
2. A speculum is inserted into the vagina to gently separate the vaginal walls and provide visibility of the cervix.
3. A small, thin instrument called a curette is inserted into the endocervical canal.
4. The curette is used to gently scrape cells from the lining of the canal.
5. The collected cells are placed on a slide or in a solution to be examined in a laboratory.

The procedure typically does not require anesthesia, though some patients may receive a local anesthetic to minimize discomfort.

Duration

The procedure usually takes about 10 to 15 minutes.

Setting

Endocervical curettage is typically performed in an outpatient clinic, a gynecologist's office, or an outpatient surgical center.

Personnel

• Gynecologist or other trained healthcare provider
• Medical assistant or nurse for support and patient comfort

Risks and Complications

• Mild to moderate discomfort or cramping
• Light bleeding or spotting
• Infection, though this is rare
• Cervical injury, which is uncommon
• Extended or excessive bleeding

Benefits

• Early detection of cervical cancer or precancerous changes
• Accurate diagnosis leading to appropriate and timely treatment
• Low-risk and minimally invasive

Recovery

• Patients can generally return to normal activities immediately.
• Light bleeding or spotting may occur for a day or two.
• Over-the-counter pain relievers can alleviate any discomfort or cramping.
• Avoid using tampons, douches, or vaginal medications for 24-48 hours post-procedure.
• Follow-up appointments may be scheduled to discuss results and any necessary further treatment.

Alternatives

• Pap smear: Often used as an initial screening tool but may not provide detailed information about cells higher in the endocervical canal.
• Colposcopy: A procedure to closely examine the cervix, vagina, and vulva for signs of disease, often performed with ECC.
• HPV testing: To check for the virus that can cause cervical changes, sometimes combined with a Pap smear.

Patient Experience

• During the procedure, you may feel some pressure from the speculum and mild cramping as the cells are scraped.
• Afterward, expect light bleeding or spotting and minor cramping.
• Communication with your healthcare provider is important to ensure comfort and understanding throughout the process.

Pain management is usually simple and effective, with over-the-counter pain medication like ibuprofen recommended for any post-procedure discomfort.