Background <p>Palliative biliary stenting is the principal treatment for unresectable perihilar cholangiocarcinoma (pCCA) patients with jaundice. Endobiliary radiofrequency ablation (EBRFA) is a novel treatment used in combination with biliary stenting for CCA, aiming to prolong stent patency and patient survival. However, the evidence regarding its safety and efficacy in perihilar CCA remains limited. This study aims to investigate the safety of EBRFA and efficacy in terms of increasing stent patency and the patient’s survival.</p> Methods <p>Patients with unresectable perihilar CCA were prospectively randomized into 2 groups, including EBRFA with self-expandable metallic stent (SEMS) and SEMS alone. Stent patency time was recorded after stent implantation and until obstructive jaundice occurred. The median survival time (MST), median stent patency, and adverse event rate were analyzed and compared using the Log-rank test. The proportion comparisons of patient characteristics, preoperative testing, procedure detail, and morbidity in two methods were conducted by the Chi-square test.</p> Result <p>Of a total of 39 patients who were diagnosed with pCCA and included in this study, 22 patients were in the EBRFA group and 17 patients were in the SEMS group. The procedure-related complication rate was not statistically significantly different between the EBRFA and the SEMS groups. There was no statistically significant difference in stent patency time between the EBRFA and SEMS groups (71 vs. 78 days, <i>p-value</i> = 0.809), and the OS of the EBRFA group had no statistically significant difference with the SEMS group (94 vs. 79 days, HR = 1.31, 95%CI: 0.66–2.58, <i>p-value</i> = 0.735).</p> Conclusion <p>The EBRFA, when combined with SEMS placement, demonstrated procedural feasibility and acceptable outcomes as a potential palliative approach for patients with unresectable pCCA.</p> Trial registration <p>TCTR20190704002.</p>