The drainage of liquid pancreatic collections is complex and technically challenging as for Its technique. In recent decades, endoscopic advances have improved technical and clinical success rates with reduced complications. We present a case of a 72-year-old male patient with severe necrotizing acute pancreatitis after endoscopic papillectomy for recurrent papillary adenoma, with evolution to infected walled-off necrosis. Percutaneous drainage guided by tomography was performed with poor clinical evolution and persistence of collections, predominantly in the tail of the pancreas of solid necrotic remains and air bubbles. Due to the location of the collection and the absence of contact with the gastric wall, percutaneous endoscopic necrosectomy was performed with placement of a self-expanding esophageal metal stent with resolution of the case. This unusual technique is proposed in a step-up approach to the management of walled-off necrosis, when the percutaneous drainage is insufficient and the transgastric endoscopic approach is not possible due to the characteristics of the collection. The management of walled-off necrosis as a late complication of acute necrotizing pancreatitis suggests a step-up approach. Endoscopic necrosectomy achieves higher resolution rates with a lower complication rate, resolution time, and cavity recurrence.