Background Lumen-apposing metal stents (LAMS) have displaced double-pigtail plastic stents (DPS) as the standard treatment for walled-off necrosis (WON),β but evidence for exclusively using LAMS is limited. We aimed to assess whether the theoretical benefit of LAMS was superior to DPS. Methods This multicenter, open-label, randomized trial was carried out in 9 tertiary hospitals. Between June 2017, and Oct 2020, we screened 99 patients with symptomatic WON, of whom 64 were enrolled and randomly assigned to the DPS group ( n  = 31) or the LAMS group ( n  = 33). The primary outcome was short-term (4-weeks) clinical success determined by the reduction of collection. Secondary endpoints included long-term clinical success, hospitalization, procedure duration, recurrence, safety, and costs. Analyses were by intention-to-treat. ClinicalTrials.gov, NCT03100578. Results A similar clinical success rate in the short term (RR, 1.41; 95% CI 0.88–2.25; p  = 0.218) and in the long term (RR, 1.2; 95% CI 0.92–1.58; p  = 0.291) was observed between both groups. Procedure duration was significantly shorter in the LAMS group (35 vs. 45-min, p  = 0.003). The hospital admission after the index procedure (median difference, − 10 95% CI − 17.5, − 1; p  = 0.077) and global hospitalization (median difference − 4 95% CI − 33, 25.51; p  = 0.82) were similar between both groups. Reported stent-related adverse events were similar for the two groups (36 vs.45% in LAMS vs. DPS), except for de novo fever, which was significantly 26% lower in LAMS (RR, 0.26 0.08–0.83, p  = 0.015). Conclusions The clinical superiority of LAMS over DPS for WON therapy was not proved, with similar clinical success, hospital stay and similar safety profile between both groups, yet a significant reduction in procedure time was observed. Trial registration number ClinicalTrials.gov, NCT03100578. Graphical abstract