Abstract Background: Endoscopic ultrasound (EUS) – guided drainage is the preferred modality for pancreatic pseudocysts and is conventionally performed with fluoroscopic assistance. However, fluoroscopy exposes patients and operators to ionizing radiation. Aim: To evaluate the feasibility, safety, and outcomes of EUS-guided pancreatic pseudocyst drainage performed without fluoroscopic guidance. Methods: Fifty-six consecutive patients, including two pregnant women, with symptomatic pancreatic pseudocysts underwent EUS-guided drainage without fluoroscopy at a tertiary care center between January 2022 and December 2024. Drainage was performed using EUS guidance alone with needle puncture, guidewire placement, cystotome-assisted tract creation, balloon dilatation, and plastic stent deployment. Results: Technical and clinical success was achieved in 100% of cases. No peri-procedural or early post-procedural complications were observed. Two double-pigtail stents were placed in selected cases(8) with thick or solid contents. Both pregnant patients had successful outcomes without adverse maternal or fetal events. Conclusion: EUS-guided pancreatic pseudocyst drainage without fluoroscopy is safe, effective, and reproducible. This radiation-free approach is particularly advantageous in special populations such as pregnant patients. Keywords: Endoscopic ultrasound, pancreatic pseudocyst, radiation-free, fluoroscopy-free, pregnancy.