Objective To evaluate the efficacy and safety of lumen-apposing metal stent (LAMS) for the treatment of pancreatic walled-off necrosis (WON). Methods A retrospective cohort study was performed on data of 43 consecutive patients with pancreatic WON who underwent endoscopic ultrasound-guided drainage by LAMS or plastic stents (PS) in Hangzhou First People''s Hospital from December 2010 to June 2020. According to the type of stent used, the patients were divided into the LAMS group (n=16) and the PS group (n=27). The technical success rate, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and adverse events were compared between the two groups. Results All 43 patients were successfully stented, indicating a technical success rate of 100% in both groups. For the LAMS group, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and overall incidence of adverse events were 75.0% (12/16), 26.0 (19.1, 39.8) min, 0.5 (0, 2.0) times, (41.3±28.4) days, and 43.7% (7/16), respectively, whereas these indices of the PS group were 37.0% (10/27) (χ2=5.795, P=0.016), 31.0 (26.0, 48.0) min (Z=1.221, P=0.222), 0 (0, 0) times (Z=2.245, P=0.025), (176.1±99.1) days (t=5.187, P<0.001) and 14.8% (4/27) (χ2=8.893, P=0.064), respectively. Conclusion LAMS placement is safe and effective for the treatment of pancreatic WON with a higher clinical success rate compared with PS. However, it requires more endoscopic intervention.