Purpose: This study aimed to compare clinical, nutritional, and endoscopic outcomes among Roux-en-Y (RY), uncut Roux-en-Y (uRY), and Billroth II with Braun anastomosis (BB) reconstruction methods in gastric cancer patients after distal gastrectomy. Methods: This retrospective study analyzed gastric cancer patients who underwent laparoscopic distal gastrectomy between January 2018 and December 2022, categorized into RY, uRY, and BB. Demographic, pathological, clinical, nutritional, and endoscopic data were collected over 24 months. Endoscopic outcomes were assessed using the RGB scoring system, evaluating residual food, gastritis, and bile reflux. Delayed gastric emptying was defined by clinical and imaging criteria. Multivariable linear regression was performed to identify relevant factors associated with 24 months RGB scores and mixed linear model was applied to assess the time interaction. Results: A total of 221 patients were included (70 RY, 75 uRY, 76 BB). Baseline characteristics, perioperative and nutritional outcomes were comparable among groups. The uRY group showed less weight loss at 3 months (5.9%, P<0.05) but did not differ in other studied periods. The RY group had the lowest RGB scores at all time points, while BB showed the highest and progressively worsening scores. Regression model showed that BB and uRY was related to increase 24 month RGB score. BB showed increased RGB score while RY was stable in time and uRY showed intermediate change in the mixed linear model (P<0.05). Conclusion The nutritional clinical outcomes were comparable between the reconstructions. RY reconstruction demonstrated favorable endoscopic outcomes, while BB was associated with higher RGB scores in time.