Once known as the most efficient cure for peptic ulcer disease, surgical gastrectomy has now become the last step of the treatment. The choice of the reconstruction technique is still controversial, although multiple studies have shown that Roux-en-Y reconstruction has less reflux related complications and may result in a better quality of life, compared to Billroth I and Billroth II. In cases of symptomatic reflux associated with previous gastric interventions, revision to Roux- en-Y has shown to be a safe option with significant benefits from co-morbidity resolution. We present a 65 years old male, who had undergone a gastrectomy for peptic ulcers disease in 1975 with a Billroth II reconstruction. He refered GERD symptoms and dysphagia. On EGD an esophageal stenosis secondary to biliary reflux was found. A conversion to roux-en-Y gastrojejunostomy was successfully accomplished and a truncal vagotomy was performed. A replaced left hepatic artery was a casual finding during surgery. The case shows the feasible technique for the treatment of biliary reflux.