Endoscopic removal of an adjustable gastric band is a feasible procedure with few complications, according to our series of 8 patients. We report the case of a 56 year-old woman who underwent endoscopic removal of a gastric band which had eroded through the gastric wall; this procedure was performed under general anesthesia, while the surgical group removed the subcutaneous port. The patient developed a large pneumoperitoneum after the procedure, and complained of back, shoulder and epigastric pain. A plain abdominal X-ray confirmed the pneumoperitoneum, and esophagogastric radiography with water-soluble contrast did not show a perforation. The treatment approach was conservative. This experience demonstrates an expected complication of endoscopic removal of an adjustable gastric band, and that the treatment may be conservative. The technique of band removal and the mechanism of pneumoperitoneum are discussed.