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To assess the efficacy and safety of ultrasound‐guided percutaneous ablation (US‐PA) for adrenal metastases (AMs) using a meta‐analysis. A systematic search of PubMed, Cochrane, Web of Science, and Embase electronic databases was performed to identify studies on US‐PA for AM. Seven studies published between January 2000 and August 2022 were analyzed, which resulted in a sample size of 140 patients. Both random effects and common effects meta‐analysis models were used to analyze the following efficacy and safety outcomes: the first and secondary technical success rate, 1‐year overall survival rates, 1‐year local tumor control rate, incidence rate of intraoperative hypertensive crises, and major complications. The subgroup analysis was performed to explore the origin of heterogeneity. Among 140 patients from 7 studies included in this meta‐analysis: 51 (36.43%) underwent radiofrequency ablation (RFA), and 89 (63.57%) underwent microwave ablation (MWA). Pooled data analysis revealed that the first and secondary technical success rates were 85% (95% confidence interval [CI], 73–96) and 99% (95% CI, 96–100), the 1‐year overall survival rate was 83% (95% CI, 71–93), the 1‐year local tumor control rate was 83% (95% CI, 75–90), and the incidence rate of intraoperative hypertensive crises was 14% (95% CI, 8–20). The overall rate of major complications was 3.6%. In the subgroup analysis, lower heterogeneity was indicated to be associated with mean tumor size and ablation type. This meta‐analysis showed that US‐PA can be both effective and safe for AM in terms of overall survival, technical success rate, and local control for AM.