Objective To study the efficacy and safety of extracorpareal shock wave lithotripsy(ESWL) combined with endoscopic retrograde cholangiopanereatography (ERCP) for difficult common bile duct(CBD) stones in elderly patients. Methods Data of 87 elderly patients (aged 70-93) diagnosed as having difficult CBD stones who were treated with ESWL combined with ERCP in the Affiliated Hangzhou First People""s Hospital, Zhejiang University School of Medicine from November 2016 to January 2020 were retrospectively analyzed. The lithotripsy success rate, complete removal rate and complications were analyzed. Results All 87 patients received a total of 189 procedures of ESWL, with an average of 2.51±0.78 procedures. The lithotripsy success rate of CBD stones was 94.25% (82 cases), including 54 (62.07%) of complete lithotripsy and 28 (32.18%) of partial lithotripsy. Incomplete lithotripsy was found in 5 (5.75%) patients. Difficult CBD stones were completely removed in 84 patients (96.55%) via ERCP, and partially removed in 3 patients (3.45%) who were placed with biliary stents. Nine patients (10.34%) had minor complications, including 2 cases (2.30%) of cholangitis, 1 case (1.15%) of pancreatitis, 3 cases (3.45%) of hyperamylasemia, and 3 cases (3.45%) of transient hemobilia. Conclusion ESWL combined with ERCP is safe and effective for difficult CBD stones in elderly patients.