Purpose: Stent placement is the standard of care for unresectable malignant biliary obstruction.The aim of our study was to retrospectively evaluate the added benefit of adding intraluminal radiofrequency ablation(RFA)to biliary metal stent placement for patients with malignant biliary obstruction.Materials and Methods: Institutional review board approval and informed consent were obtained.Our study group was formed of 137 consecutive patients who underwent treatment for malignant biliary obstruction at our institution,between November 2013 and December 2015.Of these,80 met our eligibility criteria,with 45 patients treated with percutaneous transhepatic cholangiography(PTC),intraluminal RFA,and biliary stent placement(RFA-Stent group)and 35 treated with PTC and biliary stent placement(Stent group).Groups were compared on overall survival(OS),stent patency,complication rates,and biochemical tests.Results OS and stent patency were higher for the RFA-Stent group,with a mean OS of 7.1 months compared to 5.0 months for the Stent group(Kaplan-Meier analysis,P = 0.031),with a mean patency of 5.4 months and 3.6 months,respectively(P = 0.029).The 3-month OS was higher for the RFA-Stent group than the Stent group(P < 0.05),with 6-and 12-month OS being comparable.Although stent patency at 1,6,and 12 months was comparable between groups,stent patency at 3 months was higher in the RFA-Stent group than in the Stent group(P = 0.01).The rate of complication and biomechanical tests were comparable between groups,except for a higher improvement in serum amylase level at 1-3 days post-procedure in the Stent group,compared with the level at 1-2 hours post procedure,compared to the RFA-Stent group(P < 0.05).Conclusion: The combination of percutaneous intraluminal RFA and biliary metal stent placement confers therapeutic benefits in terms of survival and stent patency,compared to stent placement alone,for the treatment of unresectable malignant biliary obstruction.