Biliopancreatic disease is a common acute abdominal disease with complicated condition and high mortality rate. The clinical application of retrograde cholangiopancreatography (ERCP) has significantly improved the prognosis of this type of disease. 32 cases of nasobiliary drainage (ENBD) and/or sphincterotomy of the papilla (EST) for biliopancreatic disease under emergency ERCP have been carried out since 2005 in our department, and the effect is satisfactory, which is now summarized and reported. The results are summarized as follows. 1.Data and methods There were 32 cases in this group, 19 males and 13 females, aged 23~102 years old, average 65 years old. The main manifestations of abdominal pain, fever, jaundice, nausea, vomiting, etc. According to the history of ultrasound and laboratory tests, the diagnosis of biliary pancreatitis in 10 cases, choledocholithiasis (combined with infection in 7 cases) in 12 cases, biliary ascariasis in 1 case, suppurative cholangitis in 9 cases. 28 patients were all admitted to the hospital in 2~24h emergency ERCP examination, according to the condition, the patient’s general state and the size and number of the bile duct stones, respectively. According to the general condition of the patient and the size and number of bile ducts, respectively, the patients underwent papillary sphincterotomy and insertion of nasobiliary drain, or papillary sphincterotomy of stones and removal of Ascaris lumbricoides, etc. The procedure was simplified as much as possible, and it did not emphasize on the one-time complete relief of the cause of the disease. Results: 28 patients were successfully intubated, the shortest operation time was 15 min, the longest was 58 min, and the average time was 35 min. 21 cases were simply performed papillary sphincterotomy and nasal biliary drainage, 6 cases were performed papillary sphincterotomy and removal of stones (3 cases of embedded stones in the papilla), and 1 case of removal of biliary ascaris lumbricoides. All patients were treated with emergency ERCP, EST and nasobiliary drainage, and their symptoms and signs (abdominal pain, fever, jaundice, etc.) were completely relieved in 1~7 days after the operation, and 4 patients were discharged from the hospital after ERCP was performed for the second time after their condition stabilized, with no obvious complications, and none of them was discharged from the hospital with cured condition. 3, Discussion: In recent years, with the general improvement and development of the application of gastrointestinal endoscopy technology, the application of ERCP, EST and ENBD for the treatment of biliopancreatic diseases has been definitely evaluated. Emergency ERCP (including EST+ENBD) is of great clinical value in saving patients’ lives, relieving symptoms and preventing disease progression, and reducing complications. It has been pointed out in the literature that the earlier the endoscopic intervention for severe acute biliary pancreatitis, the lower the complication rate and the lower the morbidity and mortality rate [1, 2]. Emergency ERCP (including EST+ENBD) can remove bile duct stones, restore bile flow, reduce bile-pancreatic reflux and infection, so that the patient’s condition can be improved rapidly and complications can be reduced to improve the overall prognosis, and the efficacy of the treatment is significantly better than the traditional conventional treatment. The common indications for emergency ERCP are bile duct stone incarceration, acute obstructive septic cholangitis, biliary ascariasis, acute biliary pancreatitis (ABP), etc. For acute biliary pancreatitis, especially in cases with clear obstructive jaundice or biliary tract infection, early endoscopic treatment should be performed and a nasobiliary drain should be placed to significantly reduce the occurrence of complications, avoid severe pancreatitis, and reduce the mortality rate. The Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis recommend that endoscopic ENBD or EST should be performed for suspected or proven acute biliary pancreatitis if it meets the indicators of severe disease and/or has cholangitis, jaundice, or bile duct dilatation, or for those who are initially judged to have a mild form of acute pancreatitis but whose condition worsens during treatment [3].Isogai et al. [4] proposed a simple evaluation index for the evaluation of emergency treatment of ABP: (1) body temperature >38℃ (2) serum bilirubin ≥2.2mg/dl (3) bile duct dilatation ≥11mm (4) ultrasound suggestive of bile duct stones. If 3 or more of the 4 indicators are positive, emergency endoscopic treatment should be performed. ENBD and/or EST under emergency ERCP should be performed within 48-72H in patients predicted to have severe ABP to relieve biliary obstructive factors. Recent evidence-based medical evidence suggests that ERCP can significantly reduce the complication rate in patients with severe ABP, although it does not significantly reduce the mortality rate in patients with mild ABP and severe ABP. Before operation, the patient’s condition should be fully understood, including laboratory tests (liver function, amylase, blood routine, B ultrasound, etc.) and general vital signs, mental state, for unstable patients such as acute obstructive septic cholangitis (AOSC) should be routinely monitored by electrocardiography, and if necessary, resuscitation and endoscopic treatment at the same time, to relieve the biliary obstruction as soon as possible to relieve the biliary pressure, which is conducive to the patient’s recovery. Avoid the one-time pursuit of relieving the cause of the disease, thus affecting the efficacy and increasing complications [5]. In our group, there is a case of AOSC patients, has been in shock state, to the family to explain the condition to obtain consent for emergency ERCP, EST and ENBD, intraoperative extraction of a large number of purulent bile, the patient’s condition stabilized faster after surgery, ten days after the second ERCP successfully removed stones, the patient was cured and discharged. Because of the condition, emergency ERCP requires intubation, incision, stone removal and insertion of drainage tubes to be completed as quickly as possible in a short period of time, and the obstruction must be relieved quickly and effectively to reduce the pressure in the bile ducts and alleviate the patient’s clinical symptoms, and prolonged operation may delay the condition and increase the risk. Emergency ERCP duodenal papilla more enlarged obvious, easy to recognize, especially the stone embedded in the papilla opening, due to increased pressure in the bile duct, the papilla is in the “one-touch” state, the author’s experience is that if two consecutive intubation is unsuccessful, can be directly line needle knife window surgery, because at this time, the papilla is enlarged with a needle knife is relatively safe and operation time is short, which is conducive to the rapid relief of the disease, and can help the patient’s clinical symptoms, prolonged operation may increase the risk of delay. Doing time is short, which is conducive to the rapid release of obstruction, relieve the patient’s symptoms. In this group of cases, 10 patients were operated with needle knife, and no complication occurred in one case. For patients with severe conditions, once the intubation is successful, it is recommended to perform ENBD quickly, paying attention to the front end of the drain should be placed over the stone, coiled in the proximal part of the common hepatic duct, and then consider the second ERCP stone extraction treatment after the condition is stabilized. Postoperatively, the drain can be flushed with antibiotic saline to prevent blockage. With the improvement of endoscopic intervention technology and the development of instruments, the superiority of emergency ERCP treatment will bring more patients with biliary and pancreatic diseases the gospel.