Objective To evaluate the safety and clinical effectiveness of biliary drainage combined with endoscopic intraductal radiofrequency ablation (RFA) for treatment of malignant biliary obstruction. Methods Eighteen patients with malignant biliary obstruction, who were unsuitable for surgical resection, were prospectively selected for this study. During endoscopic retrograde cholangiopancreatography (ERCP), when biliary cannulation was successfully done, a bipolar radiofrequency probe was introduced into the bile duct via a guide wire. RFA was done under fluoroscopy, which was followed by stent placement. The patients were closely observed and followed up after procedure. Results All patients received successful RFA and biliary drainage. Twelve patients were implanted with plastic stents and 6 with metal stents; 3 patients were also implanted with pancreatic stents. Four patients developed mild complications (2 cholangitis and 2 pancreatitis), which were controlled by conservative therapy. Jaundice was promptly controlled in 61% (11/18) patients. The patients were followed up for a median of 10.9 months (range 2.0-15.4 months). The stent patency rates of 3 months, 6 months and 12 months were 87%(13/15), 64% (9/14) and 25% (2/8), respectively. The 6 month- and 12 month-survival rates were 67% (8/12) and 50% (4/8), respectively. Conclusion Biliary drainage combined with endoscopic intraductal RFA is technically feasible and safe for treatment of malignant biliary obstruction.