Objective: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. Data sources: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. Study selection: Randomized controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomized controlled trials and were included for data extraction. Data extraction: Six studies with 263 participants were analyzed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The metaanalysis was performed with the random effects model. Data synthesis: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P= 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P= 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P <0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P= 0.16) between the two groups of patients. Conclusions: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis