Endoscopic retrograde cholangiopancreatography of geriatric patients with cholangitis: A single-center experience in central Saudi Arabia Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential tool for managing biliary diseases, particularly in geriatric patients. However, limited data exists on its safety and efficacy in geriatric population in Saudi Arabia. Methods: This prospective study evaluated ERCP outcomes in patients aged ≥70 at Prince Sultan Military Medical City, Riyadh, between November 2023 and May 2025. Patients were categorized into two groups: 70–80 years and ≥81 years. Data collected included demographics, comorbidities, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists status (ASA) physical status, Duke Activity Status Index (DASI), indications, procedural success, and 30-day complications (per Cotton's criteria). Results: Of 403 ERCPs, 363 (90.7%) were performed in patients ≥70 years old. Of those, 199 were aged 70–80 years (mean 77.67 ± 5.4 years) and 164 were aged 81–103 years (mean 87.36 ± 5.26 years). The ≥81 years age group had more males (120 of 164, 73.2% vs. 123 of 199, 61.8%; P = 0.022), lower DASI (14.8 vs. 25.12; P < 0.001), and higher comorbidity rate (156 of 164, 95.12% vs. 150 of 199, 75.38%; P < 0.001). Common indications and technique success rates were similar between groups. Overall complication rates did not differ significantly; post ERCP pancreatitis (PEP) was more frequent in younger than in the older group (8 of 199, 4.02% vs 2 of 164, 1.21%; P = 0.096). No 30-day ERCP-related mortality was reported in either group. Conclusions: ERCP was safe and effective in Saudi geriatric patients, including those ≥81 years, with complication rates indicating that age alone should not preclude its use when clinically indicated.