ObjectiveTo evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the elderly patients (80 years or older) with choledocholithiasis. MethodsA retrospective study was conducted on 742 cases of choledocholithiasis who underwent ERCP at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2014 to December 2017. The patients were divided into two groups: 196 patients aged 80 or above (the very elderly group) and 546 patients aged 60 or below (the non-elderly group). The baseline data including gender, number and size of stones of the two groups were matched using the 1∶1 propensity score matching, and the covariate equalization samples between the two groups were obtained and 196 pairs of patients were successfully matched. The treatment success rate, complication incidence, hospitalization time and cost were analyzed. ResultsComorbidities in patients of the elderly group were significantly more than those in the non-elderly group [93.4% (183/196) VS 76.5% (150/196), P＜0.001]. The success rates of treatment were 96.4% (189/196) and 96.9% (190/196)， respectively (P=0.778). The incidence of postoperative complications were 8.7% (17/196) in the elderly group and 6.6% (13/196) in the non-elderly group (P=0.447). The mean hospitalization time and the mean hospitalization cost of the elderly group and the non-elderly group were 8.20 days, 23 624.06 Yuan and 8.03 days, 22 249.64 Yuan, respectively (all P＞0.05). ConclusionERCP is effective and safe, and can be used as the first choice for senile patients with choledocholithiasis. 【Key words】