The results of oesophago-gastro-duodenoscopy (OGD) and radiology in one hundred consecutive elderly patients were reviewed to assess the efficacy, safety and acceptability of endoscopy in this age group. False positive radiological features occurred in two of nine patients with normal endoscopic examinations. The remaining ninety-one patients had 138 lesions, sixty-four of which were diagnosed by both techniques. Endoscopy missed fourteen lesions partly because of unsuccessful intubation (one patient) or incomplete examinations due to obstructive lesions (eight patients). Radiology misdiagnosed or did not demonstrate sixty-one lesions. OGD proved to be safe and relatively well tolerated; it was invaluable at confirming or refuting the diagnosis of malignancy, at detecting multiple pathology and identifying bleeding lesions, but it gave inferior results with hiatus herniae. Thus it can usefully be undertaken in the elderly as a complementary examination to radiology.