Objective: To evaluate the clinical efficacy of using external drainage of the pancreatic duct with a stent after pancreaticoduodenectomy (PD). Methods: The studies comparing the external drainage of pancreatic duct with a stent and non-drainage after PD from January 2000 to December 2017 were collected by searching the relevant databases such as PubMed, EMBASE, the Cochrane Library and Web of Science. After assessment and data extraction of the selected studies, Meta-analysis was performed. Results: Four randomized controlled trials (RCTs) were finally included, involving 458 patients with 227 cases in external drainage group and 231 cases in non-drainage group. The results of Meta-analysis showed that the overall incidence of pancreatic fistula was significantly reduced in external drainage group compared with non-drainage group (RR=0.57, 95% CI=0.40–0.82, P=0.002), which was mainly contributed by reducing the grade B and C pancreatic fistula (RR=0.57, 95% CI=0.38–0.85, P=0.006) and exerting effect in patients with pancreatic duct diameter ≤ 3.0mm (RR=0.55, 95% CI=0.37–0.82, P=0.003). In addition, the incidence of pancreatic fistula was also significantly reduced in external drainage group compared with non-drainage group among patients undergoing duct-to-mucosa anastomosis (RR=0.42, 95% CI=0.22–0.80, P=0.008). Moreover, the overall incidence of postoperative complications was significantly decreased in external drainage group compared with non-drainage group (RR=0.79, 95% CI=0.64–0.98, P=0.03). There were no significant differences in incidence of delayed gastric emptying, abdominal bleeding, intra-abdominal fluid collections, and wound infection as well as the overall postoperative mortality (all P>0.05). Conclusion: Using external drainage of the pancreatic duct with a stent after PD can effectively reduce the incidence of pancreatic fistula and postoperative complications. However, this conclusion still needs to be further verified by large sample and high quality RCTs.