Objective: To compare the clinical efficacies between percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) insertion and nasojejunal tube in enteral nutrition (EN) for severe acute pancreatitis (SAP). Methods: The treatment records of 61 SAP patients were retrospectively analyzed. Fifteen cases underwent PEG/J insertion (PEG/J group) and the other 46 cases received nasojejunal tube feeding (nasojejunal tube group). The operative time, time to first defecation, time for hemogram returning to normal, incidence of catheter-related lung infection, duration of feeding tube retention and subjective comfort levels of the two groups were compared. Results: PEG/J group had a prolonged operative time, but faster recovery of bowel function and shorter time for hemogram to return to normal compared with nasojejunal tube group (all P<0.05). In PEG/J group, the duration of tube retention was longer, but the incidence of catheter-related lung infection was lower and the subjective comfort level was better than those of nasojejunal tube group (all P<0.05). Conclusion: In early EN support for SAP, PEG/J insertion has better efficacy and fewer complications than those of nasojejunal tube feeding, which is beneficial for the late nutritional support and recovery of the SAP patients.