Chronic diseases of the digestive system are becoming more prevalent in the elderly population.To reduce the occurrence of malignant lesions in the upper gastrointestinal tract, it is important to focus on diagnosing and monitoring esophageal and gastric mucosal lesions in the elderly.The advancement of gastrointestinal endoscopy technology has led to the development of various endoscopic equipments and techniques.One such technology is confocal laser microendoscopy, which allows real-time biopsy and cytology of the mucosal surface.This technology holds significant value in the real-time diagnosis of conditions like gastroesophageal reflux disease(GERD), Barrett's esophagus, esophageal high-level intraepithelial neoplasia, early esophageal squamous carcinoma, atrophic gastritis, and pre-cancerous gastric mucosa in the elderly.Understanding the application of confocal laser microendoscopy in diagnosing esophageal and gastric mucosal lesions in the elderly is crucial for clinicians in making diagnostic and therapeutic decisions.