A highly sensitive fiber optics twist sensor is proposed and experimentally demonstrated using elliptical-core few-mode fiber (e-FMF). With the help of a fixed-phase plate for conversion from LP11 to LP01 mode, the twist angle can be linearly mapped to the spatial rotation of LP11 mode profile and consequently discriminated by monitoring the optical power variation at the standard single-mode fiber (SSMF) output. When the optical power at the e-FMF output is 10 mW, the twist angle within the range of ±39° can be successfully detected with a sensitivity of more than 20 μW/°. Meanwhile, the twist direction can be identified simultaneously. In particular, when the twist angle ranges from -12.5° to 20.1°, the sensitivity is higher than 100 μW/°. Both temperature-insensitive operation from 20°C to 150°C and e-FMF length insensitive operation are experimentally verified.