A 73-year-old female with a medical history of total gastrectomy and Roux-en-Y reconstruction was admitted to our hospital for epigastric pain. Contrast-enhanced abdominal computed tomographic (CT) scan showed a markedly dilated afferent loop with suspected anastomotic obstruction, leading to the diagnosis of afferent loop syndrome. Anastomosis stricture was so severe that we could not initially identify the anastomosis site by esophagogastroduodenoscopy, but we finally found the pinhole-like anastomosis site with leakage of yellowish-white liquid by the aid of an endoscopic distal attachment. Endoscopic balloon dilation was performed for the pinhole-like anastomosis stricture, and after that a large amount of intestinal juice flowed out through the dilated hole. Her symptoms improved together with resolution of the dilated afferent loop. Endoscopic balloon dilation is an effective treatment for afferent loop syndrome, and CT scan and attentive endoscopic examination are useful to identify the anastomosis site in such cases.
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