Objective To evaluate the safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography( ERCP) in very elderly patients( 85 years or older) with common bile duct stones. Methods A retrospective study was conducted on 150 patients with common bile duct stones who underwent ERCP in the Second Affiliated Hospital of Nanjing Medical University between January 2013 and December 2014. The subjects were divided into two groups: very elderly group of 50 patients aged 85 or above and non- elderly group of 100 patients aged 60 or below. Postoperative vital signs were closely monitored. Symptoms such as fever and abdominal pain were recorded.Blood test was performed and the level of serum amylase was determined at 3 and 24 h after ERCP. The treatment success rate,success rate of stone removal in one setting,and incidence rate of complications in the two groups were compared by chi- square test. Results The treatment success rate in very elderly group( 98. 0%) was similar to that in non- elderly group( 99. 0%)( χ2= 0. 253,P > 0. 05). The success rate of stone removal in one setting in very elderly group( 70. 0%) was significantly lower compared with that in non- elderly group( 91. 0%)( χ2= 10. 938,P < 0. 05). The incidence rate of complications in very elderly group( 8. 0%) was similar to that in non- elderly group( 12. 0%)( χ2= 0. 560,P > 0. 05). Conclusion Therapeutic ERCP is an effective and safe method for the treatment of common bile duct stones in very elderly patients and can be recommended as the first choice of treatment.