Abstract: Along with the social aging intensifies, super-aged population with biliary and pancreatic diseases is dramatically increasing, most of whom are characterized by poor general conditions and more complex comorbidities, bringing great challenges to clinical diagnosis and treatment. Endoscopic retrograde cholangiopancreatography (ERCP) is especially suitable for ultra-elderly patients who are not good candidates for surgery. ERCP has great advantages in the management of biliary and pancreatic diseases, such as choledocholithiasis, biliary-pancreatic malignancies. In this review, we take a systematic literature review and focus on addressing the role of ERCP in the treatment of ultra-elderly patients with biliary-pancreatic diseases.