Objective To investigate the risk factors for choledocholithiasis recurrence after emergency endoscopic choledocholithotomy in elderly patients with choledocholithiasis complicated with acute cholangitis. Methods The clinical data of patients aged over 60 years with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography （ERCP）， small sphincterotomy （sEST） combined with endoscopic balloon dilation of the nipple （EPBD） in the First Affiliated Hospital of Anhui University of Science and Technology from January 2018 to October 2022 were retrospectively analyzed. According to the postoperative follow­up of choledocholithiasis recurrence， the patients were divided into recurrence group and non­recurrence group. The clinical data of patients with choledocholithiasis were compared between the two groups to analyze the risk factors of choledocholithiasis recurrence. Results The recurrence rate of choledocholithiasis was 18.52% （20/108）. Univariate analysis showed that parapillary duodenal diverticulum， biliary stent， number of common bile duct stones ≥ 2 pieces and mechanical lithotripsis were risk factors for recurrence of common bile duct stones after endoscopic stone removal （P < 0.05）. Multifactor Logis­tic regression analysis showed that biliary stents， the number of common bile duct stones ≥ 2 pieces and mechanical lithotripsy were independent risk factors for the recurrence of common bile duct stones after endoscopic lithotomy （P < 0.05）. Ursodeoxycholic acid for 6 months after surgery could reduce the recurrence of choledocholithiasis （P < 0.05）. Conclusion Biliary stents， the number of choledocholithiasis ≥ 2 pieces and mechanical lithotripsy were independent risk factors for choledocholithiasis recurrence in elderly patients after endoscopic lithotomy， and ursodeoxycholic acid for six months after surgery was beneficial to reduce choledocholithiasis recurrence.