Difficult to Pass: Cholangitis With Vertical Band Stenosis.

As techniques have been refined, more patients in the United States have undergone bariatric surgery for weight loss. These surgeries alter the gastrointestinal tract to restrict caloric intake. While most surgeons prefer sleeve gastrectomy and Roux-en-Y gastric bypass, some older procedures, like vertical band gastroplasty, have fallen out of favor due to late complications. In any bariatric procedure, endoscopy can be challenging if indicated due to altered anatomy. Here, we present a case of challenging anatomy due to remote vertical band gastroplasty in a patient presenting with cholangitis, highlighting the effective use of a lumen-apposing metal stent across a vertical band stenosis.