Background <p>Endoscopic ultrasound (EUS)- guided drainage has emerged as a novel technique for managing pelvic abscesses. This single-center retrospective case series aims to assess the safety and efficacy of EUS-guided drainage in treating pelvic abscesses of varying etiologies from 2021 to the present.</p> Methods <p>Consecutive patients with pelvic abscesses who underwent EUS-guided drainage were retrospectively reviewed. Etiologies included appendiceal abscess secondary to acute appendicitis (<i>n</i> = 1), pelvic abscesses resulting from anastomotic leaks following rectal cancer surgery (<i>n</i> = 2), and perianal abscesses associated with Crohn’s disease (<i>n</i> = 7). The primary outcome was technical success and reduction in abscess cavity size, assessed via follow-up imaging. Clinical success was defined as significant reduction or complete resolution of the abscess cavity size on follow-up imaging at one-month post-procedure, accompanied by clinical symptom resolution and without the need for additional interventions. Secondary outcomes included post-procedural complications and resolution of the abscess without additional interventions.</p> Results <p>EUS-guided drainage was technically successful in all cases. The median reduction in abscess size was statistically significant (Mean SD: 24.1 ± 11.11, <i>p</i> &lt; 0.05). During follow-up, imaging results confirmed significant reduction in the size of pelvic abscesses in 9 patients, except for one case at the 1-month post-procedure. None of the patients required further surgical intervention, and 2 cases recurrences were observed in the sixth- and tenth-months post-procedure. Additionally, no procedure-related complications were reported.</p> Conclusion <p>EUS-guided drainage is a safe and effective therapeutic option for managing pelvic abscesses of various etiologies. Its efficacy, particularly in Crohn’s disease-related cases, and the absence of complications in this cohort, suggest significant potential for broader clinical application.</p>