Lumen-apposing metal stents (LAMSs) have been specifically designed for the endoscopic drainage of pancreatic fluid collections and walled-off necrosis. Lately, LAMS indications have expandedto other anastomoses, and these stents have proven to be effective in multiple situations. Safety data for this device are still limited, most studies to date being focused on intraoperative complications and not long-term issues. There are little data regarding the best timing for removal and the risks associated in leaving them in place for long duration. In addition, not all the procedure-related complications have the same clinical impact, and the settings in which LAMS have been used are heterogeneous, leading to different safety profiles and outcomes. A wide consensus on the definition of complications and a list of key performance measures for LAMS placement seems mandatory to allow for a robust assessment of their long-term outcomes.