Objective To investigate the clinical application value of simultaneous three-endoscope(lap-aroscope,choledochoscope and duodenoscope)combined with endoscopic nasobiliary drainage(ENBD)in the treatment of acute severe cholangitis.Methods A total of 56 patients with choledocholithiasis complicating a-cute severe cholangitis admitted and treated in this hospital from January 2018 to December 2023 were select-ed as the study subjects and divided into the nasobiliary duct group(n=24)and the T tube group(n=32)ac-cording to the different drainage methods.The nasobiliary duct group adopted the simultaneous three-endo-scope combined with ENBD,the T tube group adopted the two-endoscope(laparoscopy and choledochoscope)T tube placement for drainage.The intraoperative and postoperative complications occurrence situation was compared between the two groups.Results Compared with the T tube group,the tube indwelling time in the nasobiliary duct group was shorter compared with the T tube group,the bile drainage volume on postoperative 1,2,3 d was less,and the differences were statistically significant(P＜0.05).The two groups all completed the operation and successfully placed the tube.All patients were smoothly discharged without death case.The electrolyte disturbance occurrence rate in the nasobiliary duct group was lower than that in the T tube group(4.2％vs.21.9％),and the difference was statistically significant(P＜0.05).The postoperative follow up lasted for 6-12 months.A total of 48 cases conducted the abdominal color ultrasound examination or magnet-ic resonance cholangiopancreatography(MRCP),the re-examination rate was 85.7％,no long-term complica-tions such as biliary stricture,regenerating stone and cholangitis were found.Conclusion Simultaneous lapa-roscopy,choledochoscopy and duodenoscopy combined with ENBD in emergency is safe and effective in the treatment of partial cases of choledocholithiasis complicating acute severe cholangitis.