Whether enteral nutrition (EN) is superior to parenteral nutrition (PN) in critically ill patients with severe acute pancreatitis remains unknown. The objective of this meta-analysis was to assess the effects of EN versus PN on clinical outcomes in a subgroup of pancreatitis patients. Relevant randomized controlled trials (RCTs) were searched in Scopus, PubMed and Web of Science from inception to August 2016. Ultimately, five RCTs including 348 patients were enrolled in this analysis. Compared with PN, EN was associated with a significant reduction in overall mortality (risk ratio (RR) = 0.36, 95% confidence interval (CI) 0.20-0.65, P = 0.001) and the rate of multiple organ failure (RR = 0.39, 95% CI 0.21-0.73, P = 0.003). EN should be recommended as the preferred route of nutrition for critically ill patients with severe acute pancreatitis.