Even though endoscopy is performed in patients of all ages, currently there is little literature on this topic in elderly patients. As a result of population demographics the use of endoscopy is expected to rise in this section of the population. Elderly patients represent a special group of patients, as they usually have a higher incidence of co-morbid diseases and may be more susceptible to endoscopic interventions. Due to the decreased physiologic reserve and associated diseases, complications in elderly patients can be more severe than in adult or young subjects. Moreover, ethical considerations play a special role in elderly frail patients with a potential poor prognosis. Thus, the endoscopist needs to pay special attention when considering or performing endoscopy in elderly patients. The aim of this article is to review the role of endoscopy in elderly patients, paying special emphasis on indications, special precautions and specific interventions.