Background/Aims: In Japan, studies on the use of colonoscopy in the elderly population are few. This study evaluated tolerance and diagnostic yield of colonoscopy in elderly patients. Methodology: We prospectively studied 515 consecutive colonoscopies performed over a 23-month period. A total of 110 patients 80 years of age or older who underwent colonoscopy from May 2003 to March 2005 were studied. We analyzed the following factors: indications for colonoscopy, endoscopic findings, total colonoscopy rates, and complications. Results: Of the 515 procedures performed, 405 (78.6%) in patients less than 80 years of age (265 men, 140 women; median age 64 years, range 18-79 years), and 110 (21.4%) were in patients aged 80 years or older (62 men, 48 women; median age 83 years, range 80-94 years). The percentage of positive fecal occult blood test in younger patient group is high, and rectal bleeding is frequent in older patient group. There was a significantly higher frequency of colorectal cancer in the elder patients (p=0.04). There was no significant difference in total colonoscopy completion rate between the two groups. Two patients in younger group had delayed bleeding, and post-polypectomy bleeding occurred in one patient in elder group. Conclusions: Colonoscopy in patients 80 or more years of age is safe, effective, and has a high diagnostic yield.