Objective To study the risk factors for complications after endoscopic retrograde cholangiopancreatography (ERCP) in super-aged patients (≥80 years). Methods Clinical data of 512 super-aged patients with pancreaticobiliary diseases who underwent 638 ERCP procedures at the Digestive Endoscopy Center, Zhongnan Hospital of Wuhan University, from July 2011 to June 2021, were studied retrospectively. Indications and results of the ERCP operations were analyzed. Multivariate logistic regression model was used to analyze the risk factors for ERCP-related complications. Results The total success rate of ERCP cannulation in super-aged patients was 94.0% (600/638), which showed no difference compared with that of patients of <60 years old (2 433/2 557, 95.2%) or patients of 60~<80 years old (2?815/3 004, 93.7%) (χ2=5.49, P=0.064). The overall incidence of post-ERCP complications was 15.2% (97/638), and the in-hospital mortality was 2.1% (11/512), which showed significant difference compared with patients of <60 years old (8/1 809, 0.4%) and patients of 60?<80 years old (21/2 127, 1.0%) (χ2=13.39, P=0.002). Multivariate regression analysis showed that hypertension (HR=1.94, 95%CI: 1.237-3.041, P=0.004), history of upper gastrointestinal reconstruction (HR=2.28, 95%CI: 1.064-4.891, P=0.034), endoscopic sphincterectomy (HR=1.65, 95%CI: 1.012-2.679, P=0.045), early procedure period (HR=0.57, 95%CI: 0.352-0.923, P=0.022), operation time >30 minutes (HR=1.74, 95%CI: 1.094-2.759, P=0.019), preoperative white blood cell count >9.5×109/L (HR=2.66, 95%CI: 1.661-4.257, P<0.001) and procalcitonin ≥0.05 ng/L (HR=2.54, 95%CI: 1.172-5.513, P=0.018) were independent risk factors for post-ERCP complications. Conclusion ERCP is safe and effective for super-aged patients. However, much attention should be paid to post-ERCP complications of patients with hypertension, history of upper gastrointestinal reconstruction, endoscopic sphincterectomy, operation time >30 minutes, preoperative white blood cell count >9.5×109/L and procalcitonin ≥0.05 ng/L to avoid serious adverse events such as mortality.