To present clinical and procedural data  of patients over 80 years of age who underwent  ERCP.

We retrospectively reviewed a prospectively collected single-center database of adult patients who underwent ERCP between 1/1/2022 and 31/5/2025 in a tertiary Greek public hospital. Data collected included demographic characteristics, indications for ERCP, clinical outcomes., and complications rates both immediate and within 2-week s post procedure. These data were compared with an historical cohort from the same center, consisting of patients under 80 years of age who underwent ERCP between 9/2021 and 12 /2023.

A total of 1729 ERCP were performed during the study period. Among these 31.1% (n=538) were performed in patients aged > 80 years (54.1% female) and 5.03% (n=87). In patients aged > 90 years. These were compared with 695 patients under 80 years from the historical cohort.

The most common indication for ERCP in patients >80 years was choledocholithiasis 53.5% (n=288) percentage similar to the historic cohort 42% (n=292), (p>0.05). The second most common indication was malignant biliary obstruction 19.9% (n=107) compared with 28.6% (n=199), (p>0.05). in the younger cohort (p>0,05). The third commonest indication was acute cholangitis 17.7% (n=95) compering with 13.4% (n=79), (p>0.05).

Sphincterotomy was performed in 61.5% (n=331) of older patients and 27.1% (n=146) had a prior sphincterotomy.

Post ERCP bleeding occurred in 4.87% (n=25), including 4 delayed cases, vs 2.73% in the historic group (p=0.048). Post ERCP pancreatitis occurred in 1.95% (n=10) vs 0.72% (p>0.05),  cholangitis 1.36% (n=7) vs 0.29% (p=0.033), cardiopulmonary complications 0.59% (n=3) vs 0.83% (n=6) (p>0.05) and death 0.39% (n=2).

Completeness of procedure of ERCP was 96.5% (n=494). Causes of incomplete ERCP included anatomical reasons (duodenal diverticula, altered anatomy) 56.3% (n=9), malignant infiltration 25% (n=4) and patient/anesthesia related complications 18.7% (n=3).

In a tertiary reference center approximately one third of all ERCP procedures were performed in patients over 80 years of age. One quarter of these patients over 80 years had previously undergone sphincterotomy. The most common indication, (> 50%) is choledocholithiasis did not differ between age groups. Complications rates were generally comparable between patients above and below 80 years, indicating that ERCP is a safe and effective procedure in very elderly patients when performed in an experienced center.