Objective:To evaluate the effect of pancreatic external stent used in pancreaticoduodenectomy on postoperative pancreatic fistula. Methods:Literature search was conducted in Chinese electronic database including Wanfang Database,CNKI and Chinese Biological Medicine Database,and English electronic database including PubMed,Web of Science and Cochrane Central Register of Controlled Trials. Clinical randomized controlled trials regarding the comparison of external stent and no stent were selected for inclusion. Risk ratio (RR) with the corresponding 95% confidence interval (CI) was used for overall effect estimation. Data were extracted for meta-analysis. Results:Overall,six studies met the inclusion criteria with 280 patients in the external stent group and 281 in the no stent group. Meta-analysis showed that there was a significant difference between two groups in pancreatic fistula rate(RR = 0.54,95% CI = 0.39 ~ 0.74),especially in subgroups of grade B and C (RR = 0.55,95% CI = 0.37 ~ 0.82),and non-dilated pancreatic duct (RR = 0.50,95% CI = 0.34 ~ 0.73)(P < 0.05). Meanwhile,the differences between two groups in postoperative morbidity and hospital stay were also statistically significant (P < 0.05). However,no significant differences in mortality,abdominal abscess,hemorrhage,delayed gastricemptying,blood replacement,reoperation,operation time and operative blood loss were found between two groups (P > 0.05). Conclusion:Using pancreatic external stent could effectively reduce the incidence of postoperative pancreatic fistula,and improve postoperative course. The method is safe,feasible,and worthy of popularization and application clinically.