To select the best reconstruction method after distal gastrectomy, we analyzed the endoscopic features and gastrointestinal quality of life in patients who underwent either Billroth I or Roux-en-Y reconstruction. The Billroth I procedure is simpler, more physiologically normal, and allows easier endoscopic access to the duodenum. Although it is more complex, the Roux-en Y procedure can prevent bile reflux, is safe, and is superior to the Billroth I procedure both functionally and symptomatically. The Roux-en-Y procedure is thus one of the best options after distal gastrectomy. Selection of the reconstruction procedure should be based on clinical evidence.