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.