Objective To evaluate the long‑term efficacy of endoscopic transluminal drainage(ETD) for acute pancreatitis complicated with walled‑off necrosis (WON) or pancreatic pseudocyst (PPC). Methods A total of 79 patients who were diagnosed as having WON or PPC by abdominal CT or ultrasound and treated with ETD in Nanjing Drum Tower Hospital were enrolled. Past medical records and follow‑up by phone call after discharge were analyzed for long‑term outcomes including endocrine and exocrine functions and long‑term quality of life. Results A total of 50 patients were enrolled, including 31 patients with infected WON/PPC and 19 patients with uninfected WON/PPC. Seventeen patients (54.84%) in the infected WON/PPC group and 11 patients (57.89%) in the uninfected WON/PPC group lost 5% or more of their weight. There were no significant differences in the proportion of cases of weight loss of 5% or more (P=0.833), or the weight loss between the two groups (12.59±8.89 kg VS 10.91±2.47 kg, P=0.522). Only one patient in the infected WON/PPC group had chronic abdominal pain. There was no significant difference in the Izbicki score between the two groups (23.79±6.74 VS 22.03±3.21, P=0.295). None of the patients developed steatorrhea after discharge. Five patients (16.67%, 5/30) in the infected WON/PPC group and 6 patients (40.00%, 6/15) in the uninfected WON/PPC group developed endocrine insufficiency with no significant difference (P=0.140). Greater risk of secondary diabetes resulted from higher low‑density lipoprotein cholesterol (HR=1.9, 95%CI: 1.0-3.4, P=0.044)and triglycerides (HR=1.2, 95%CI: 1.0-1.3, P =0.029). Conclusion ETD is safe and effective for WON and PPC. But there is possibility that patients develop secondary diabetes. Additionally, greater risk of secondary diabetes results from higher low‑density lipoprotein cholesterol and triglycerides.