Yaz gallstones may develop when cholesterol-heavy bile sits within the gallbladder and stagnates. The excess cholesterol forms tiny crystals, which clump together into larger particles. These particles form the basis of stones. This process may occur because Yaz birth control causes the liver to secrete higher-than-normal levels of cholesterol while reducing gallbladder motility (i.e. contractions).
Stones can remain within the gallbladder or migrate into the common bile duct, a part of the biliary tree that leads to the small intestine. When stones cause Yaz gallbladder disease, the most common form of treatment is to surgically remove the organ. This procedure, however, does not resolve bile duct stones. A different approach is required: ERCP with endoscopic sphincterotomy.
How ERCP Is Used To Detect Yaz Gallstones
Diagnosing gallstones that are present within the bile duct is usually a multi-step process. Preliminary blood tests may show elevated levels of bilirubin and alkaline phosphatase; both indicate the possibility of bile duct stones.
An imaging test called ultrasonography may further support this suspicion. However, this test is used primarily for detecting stones in the gall bladder; it is far less accurate for imaging the duct system. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) are more accurate than ultrasonography. The downside is that both require the injection of a contrast dye in order to produce images of the bile ducts.
These diagnostic tests build a case for conducting a more invasive test called endoscopic retrograde cholangiopancreatography (ERCP). A thin, flexible instrument called an endoscope is inserted into the patient's mouth. It is passed down the esophagus, through the stomach, and into the duodenum (the top portion of the small intestine).
The endoscope is positioned near the sphincter of Oddi, a valve that separates the bottom of the biliary tract from the duodenum. A thin tube is passed through the endoscope, past the sphincter of Oddi, and into the bile duct. A radiopaque dye is released into the duct and flows up the biliary tract. X-rays are taken to examine the structure and identify obstructions. If Yaz gallstones are detected within the duct, they can be removed with a procedure called endoscopic sphincterotomy.
Removing Bile Duct Stones With Endoscopic Sphincterotomy
The thin tube through which the radiopaque dye was released is removed. In its place, another instrument is passed through the endoscope. The purpose of this second instrument is to make a small incision in the muscles of the sphincter of Oddi, thus widening the opening into the small intestine. An alternative approach is called endoscopic balloon dilation; a balloon is inflated in the sphincter of Oddi to enlarge the opening.
Sometimes, the bile duct stones spill into the duodenum on their own. If this does not occur, they must be retrieved from the biliary tract. A catheter is passed through the endoscope into the bile duct. Its tip is equipped with a tiny basket, which is used to collect the stones for extraction.
This two-pronged approach (i.e. ERCP with endoscopic sphincterotomy) has a 90% success rate and prevents bile duct stones from causing serious problems.
Risks Of Not Treating Bile Duct Stones
If bile duct stones are left untreated, they can cause bile to back up within the biliary tree. This leads to further inflammation of the gallbladder. It can also set the stage for infection as bacteria climbs upward from the small intestine, through the tree, and into the gallbladder and liver.
If the stones migrate further down the bile duct, they can block the passage of pancreatic secretions. This leads to pancreatitis, a medical emergency that is potentially life-threatening.
Otherwise healthy women have suffered Yaz gallbladder problems and gallstones after using this oral contraceptive. When symptoms present, the gallbladder is almost always surgically removed. Common bile duct stones, however, pose an additional problem. ERCP with endoscopic sphincterotomy is required to remove them to prevent dangerous side effects.
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