Abstract: Objective To explore the clinical value of emergency endoscopy in elderly pa-tients with severe acute cholangitis (ACST).Methods 76 old patients with ACST were randomly divided into endoscopy group and operation group,38 cases in each group.The patients in both groups were given comprehensive treatment,including anti-infection and anti-shock therapies, nutritional support and correction of fluid and electrolyte imbalance.Based on the conventional ther-apy,endoscopy group was treated with endoscopy,while operation group was treated with surgical operation.Body temperature recovery time,biliary drainage time,operation time and total treat-ment time were observed in two groups,and mortality,healing rate and incidence rate of complica-tions were compared.Results In terms of body temperature recovery time,biliary drainage time, operation time and total treatment time,the applied time in endoscopy group was significantly shorter than the operation group.Compared with the operation group,the healing rate was slightly higher and mortality was slightly lower in endoscopy group.The incidence rate of complications in endoscope group was significantly lower than operation group.Conclusion Compared with surgical operation,endoscopy treatment has lots of advantages such as little trauma,short treatment time, low incidence rate of complications and good efficacy,and it can be considered as an optimal method for treating old patients with ACST.