Background: Therapeutic ERCP has an established role in the treatment of pancreatobiliary diseases, but little information is available on the outcomes of this procedure in patients 90 years of age and older. Objective: To evaluate the efficacy and the safety of therapeutic ERCP in an extremely elderly cohort. Design: Retrospective study. Setting: Two Greek cohorts of patients ≥ 90 and 70 to 89 years of age who underwent therapeutic ERCPs. Patients: Sixty-three patients aged 90 years and older (group A) and 350 patients 70 to 89 years of age (group B). Interventions: A retrospective review of therapeutic ERCPs was performed between 1994 and 2000 on both groups, identified by using a database linked to the endoscopy reporting system in our department. Main Outcome Measurements: Efficacy and safety of therapeutic ERCPs. Concomitant diseases, complications, and outcome were also evaluated. Results: Group A patients had a higher incidence of concomitant diseases than group B patients (100% vs 72.8% , respectively). The rate of post-ERCP early complications was low in both groups: 6.3% in group A and 8.4% in group B. The frequency of ERCP related mortality was 1.6% (1 patient) in group A and 0.6% (2 patients) in group B. Group A required endoscopic sessions for stone clearance and mechanical lithotripsy more frequently than group B (20.6% vs 11.4% and 17.5% vs 10.3% , respectively). No patient in either group experienced subjective deterioration inmental status, and the 3 patients who died required ventilatory support before death. Late complications occurred in 2.3% of patients in group B. Conclusions: Therapeutic ERCP is safe and effective for the treatment of pancreatobiliary diseases in extremely elderly patients, and advanced age per se should not impinge on decisions relating to its use. Background: Therapeutic ERCP has an established role in the treatment of pancreatobiliary diseases, but little information is available on the outcomes of this procedure in patients 90 years of age and older. Objective: To evaluate the efficacy and the safety of therapeutic ERCP in an extremely Setting: Two Greek cohorts of patients ≥ 90 and 70 to 89 years of age who underwent therapeutic therapeutic ERCPs. Patients: Sixty-three patients aged 90 years and older (group A) and 350 patients 70 to 89 years of age (group B). Interventions: A retrospective review of therapeutic ERCPs was performed between 1994 and 2000 on both groups, identified by using a database linked to the endoscopy system in our department. Main Outcome Measurements: Efficacy and safety of therapeutic ERCPs. Concomitant diseases, complications, and outcome were also evaluated. Results: Group A patients had a higher incidence of concomitant diseases than group B patients (10 0% vs 72.8%, respectively). The rate of post-ERCP early complications was low in both groups: 6.3% in group A and 8.4% in group B. The frequency of ERCP related mortality was 1.6% (1 patient) in group A and 0.6% (2 patients) in group B. Group A required endoscopic sessions for stone clearance and mechanical lithotripsy more frequently than group B (20.6% vs 11.4% and 17.5% vs 10.3%, respectively). No patient in either group experienced subjective deterioration inmental status, and the 3 patients who died required ventilatory support before death. Late complications occurred in 2.3% of patients in group B. Conclusions: Therapeutic ERCP is safe and effective for the treatment of pancreatobiliary diseases in extremely elderly patients, and advanced age per se should not impinge on decisions involved to its use.