Objective To compare the application of endoscopic retrograde cholangiopancreatography (ERCP) in the patients at different ages in order to explore the safety and efficacy of the approach in the elderly. Methods A total of 360 patients undergoing ERCP in our hospital between January 2012 and January 2015 were collected and retrospectively studied. They were divided into very old group (≥75 years old, n＝120), old group (60-75 years old, n＝123), and the non-elderly group (≤60 years old, n＝117). Their operation conditions and complications were investigated and compared among the 3 groups. Results There were overall 377 ERCP procedures performed in the 360 cases. There were no significant differences in the success rate of ERCP procedure and incidence of complications among the 3 groups (P＞0.05). Conclusion Diagnostic and therapeutic ERCP exerts similar efficacy in the elderly as in the non-elderly patients. ERCP is safe and effective in the patients at different ages.