Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a valuable minimally invasive therapeutic method for pancreatobiliary diseases and is now utilized in numerous hospitals. As the population ages, greater attention must be paid to the risk of ERCP complications, since even minor issues can be fatal for older patients. The primary objective of this study was to compare the clinical outcomes of ERCP in elderly versus non-elderly patients, as well as to validate the procedure's safety and feasibility. Additionally, the article provides a detailed, step-by-step description of ERCP procedures to assist in clinical practice. Among the 1,240 patients who underwent ERCP in the past 5 years, over 65.5% were elderly. We compared the perioperative clinical data and success rates of both groups. After thorough preoperative evaluation, the analysis revealed no significant differences in overall success rates or complication rates between elderly and non-elderly patients. These results indicate that ERCP is a safe and effective intervention for elderly patients.