Abstract: Objective To assess the efficacy and safety of Gabexate Mesilate in treating acute pancreatitis. Methods Databases such as CBM (1978 to September 2012), CNKI (1979 to September 2012), WanFang Database (1999 to September 2012) and VIP database (1989 to September 2012) were searched on computer, and the relevant journals such as Chinese Journal of Digestion (1990 to September 2012) were also hand researched to investigate references. We collected randomized controlled trials (RCTs) about Gabexate (experimental group) compared with non-Gabexate (control group) in treating acute pancreatitis. The data were extracted according to the inclusion and exclusion criteria by two reviewers independently, the quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0, and meta-analysis was conducted by using RevMan 4.2 software. Results Among 6 RCTs involving 475 patients, 243 patients were in Gabexate group and 232 patients were in control group. The quality of the included studies was in high bias risk or uncertainty bias risk. The results of meta-analyses showed that the experimental group was more effective than the control group in easing abdominal pain (WMD= -2.08, 95%CI -2.88 to -1.28) and promoting serum amylase recovery (WMD=-1.81, 95%CI -2.73 to -0.90). There were no significant differences in effective rate (WMD=1.15, 95%CI 0.96 to 1.38). Additionally, the adverse reactions incidence in experimental group was low. Conclusion For treating patients suffering from acute pancreatitis, the Gabexate Mesilate is much more effective than the control group in easing abdominal pain and promoting serum amylase recovery.