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Although ERCP is an established and effective procedure, it is associated with early adverse events, particularly in elderly patients. Older individuals frequently have multiple comorbidities, are often treated with antithrombotic agents, and may have underlying oropharyngeal dysphagia, all of which increase the risk of complications such as bleeding, hypotension, and aspiration pneumonia. In addition, bile duct stones in elderly patients tend to be larger and more numerous, and the high prevalence of periampullary diverticula may limit the extent of endoscopic sphincterotomy, thereby prolonging procedure time and increasing procedural complexity. Recent evidence has also demonstrated an association between frailty and post\u2010ERCP mortality. 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