BACKGROUND: Until recently, laparoscopic ultrasound (LUS)-guided biopsy has been difficult with the available probes on the market. This study aimed to present a new laparoscopic ultrasound probe (Hitachi, EUP-OL531) for guided biopsy and describe its impact on the clinical outcome for patients with upper gastrointestinal (UGI) cancer. METHODS: Patients referred with confirmed UGI cancer from June 2003 to December 2006 were included in the study. After a standard workup including computed tomography, endoscopic ultrasound, and ultrasound of the neck, operable patients underwent LUS with or without fine-needle aspiration (FNA). RESULTS: From a total of 175 patients, 19 (11%) underwent LUS-guided FNA after a significant lesion was found. The LUS-guided FNA confirmed distant metastasis in 14 of the 19 patients and changed the clinical management for these 14 patients (8%). There were no adverse events due to LUS or LUS-guided FNA. CONCLUSION: The current results with the new LUS probe for guided FNA are encouraging in terms of its diagnostic ability, safety, and ease of use.