Objective To evaluate the application value of emergency endoscopic needle-knife sphincterotomy（NKS） on acute cholangitis of severe type （ACST） resulting from impacted common bile duct stones at duodenal papilla. Methods A retrospective study was performed on the data of 90 ACST cases with impacted common bile duct stones at the native papilla and undergoing emergency NKS between January 2011 and January 2017 in Tianjin Nankai Hospital. The completion of treatment，mean operating time， impacted stone clearance rate， changes of laboratory indexes before and after endoscopic procedure， and complications were analyzed. Results All the 90 patients underwent emergency NKS successfully， with a total success rate of 100.0％. The mean operating time was 25.2±11.7 min. The impacted stone clearance rate was 95.6％（86／90）. The complication rate was 5.6％ （5／90）， including 3 cases of hemorrhage and 2 cases of post-ERCP pancreatitis. There was no procedure-related mortality. The postoperative white blood cell count， serum procalcitonin，total bilirubin， direct bilirubin， and glutamic-pyruvic transaminase decreased significantly compared with pre-operation （all P＜0.001）. Conclusion Emergency NKS is effective and safe for treatment of ACST resulting from impacted common bile duct stones at duodenal papilla with a relative high application value.