Abstract: Objective To investigate the curative effect of endoscopic retrograde cholangiopancreatography (ERCP) on elderly patients with choledocholithiasis and its effect on the levels of serum cancer antigen 19-9 (CA 19-9) and inflammatory. Methods Total 95 elderly patients with choledocholithiasis admitted to Ningbo Second Hospital from March2017 to May 2018 were selected. According to the wishes of the patients and their families, 61 patients underwent ECRP lithotripsy were assigned into the observation group and 34 patients underwent surgical treatment into the control group.The success rate of lithotripsy and the related surgical indicators of the two groups were compared and analyzed. The incidence of complications and changes of serum CA19-9 and inflammatory level before and after operation were observed. Results The success rate of stone extraction was 93.44% in the observation group and 97.05% in the control group.There was no significant difference in the success rate of the two groups (P > 0.05). The operation time, the time lying in bed and the time of hospitalization in the observation group were significantly shorter than those of the control group (all P < 0.05). There was no significant difference between the two groups of anti-infection treatment time, abdominal pain relief time and the general time of jaundice regression (all P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (P < 0.05). The average levels of serum CA19-9 three days after the operation decreased significantly when compared with that before operation (all P < 0.05), and the serum CA19-9 level three days after the operation in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion ERCP for the elderly choledocholithiasis is an effective method, with small body trauma, faster recovery, less complications, and good success rate of stone removal. It can effectively reduce the level of postoperative inflammation and the level of serum CA19-9. It is worthy of clinical application.