A 37-year-old man had severe acute alcoholic pancreatitis complicated with walled-off necrosis (WON) involving 90% of the gland, with extension to the left paracolic space. EUS-guided transgastric drainage was performed by use of a lumen-apposing metal stent (LAMS) (Hot Axios, Boston Scientific, Marlborough, Mass, USA) and an intraluminal double-pigtail stent (A). Additionally, two 14F percutaneous drains were placed and irrigated with hydrogen peroxide, with extraction of scarce necrosis.