Objective To assess the safety of esophageal and gastric endoscopy for elderly patients with coronary heart disease(CHD) by monitoring the changes of their vital signs during operation process. Methods A total of 60 patients over 60 years old accepting esophageal and gastric endoscopy were divided into CHD group(with mild ST-T change or history of angina or old myocardial infarction but without respiratory diseases) and control group(without heart diseases), with 30 in each group. The heart rate, blood pressure, oxygen saturation(SpO2) and electrocardiogram during performance of esophageal and gastric endoscopy were compared between the two groups. Results Heart rate was significantly increased during operation in both groups(P＜0.05), and the variation in CHD group was greater than that in control group(P＜0.05). Blood pressure was also increased in both groups(P＜0.05) and there was no significant difference between two groups(P＞0.05). SpO2 was significantly decreased in CHD group(P＜0.05) during operation but with no significant difference compared with control group(P＞0.05). Arrhythmia, but no dangerous arrhythmia, oc-curred in both groups during operation. In addition, there were 6 cases with ST-T changes in CHD group and all cases recovered to normal after operation. Conclusion With full preparation before operation and electrocardiographic monitoring if necessary during operation, esophageal and gastric endoscopy is safe for elderly patients with CHD.