Conventional imaging studies are often not sensitive enough to allow accurate preoperative staging of intra-abdominal tumour spread. Laparoscopy and laparoscopic ultrasound appear to be suitable to improve staging of gastrointestinal tumors. Within a 10-month period 40 patients with upper GI tract cancer underwent laparoscopy for intra-abdominal staging. Additionally laparoscopic ultrasound was performed on 20 of these patients using a flexible echo-endoscope equipped with a curved array transducer (5/7.5 MHz). By laparoscopy additional information compared to conventional staging was obtained in 16 patients (40%). Laparoscopy revealed peritoneal carcinomatosis and liver metastases in seven and four patients, respectively. M1-lymph nodes were detected in four patients. Laparoscopic ultrasound was able to image otherwise inaccessible regions of the abdominal cavity and induced a change of staging in seven of 20 patients in whom laparoscopy was uneventful. Ultrasound also proved to be valuable for localization of M1-lymph nodes. In summary, combination of laparoscopy and laparoscopic ultrasound improved staging in 23 of 40 patients (57%). Consequently surgery was abandoned in 16 patients due to incurable or non-resectable disease, while down-staging occurred in seven patients, who subsequently underwent resection. Laparoscopy is capable of improving staging of intra-abdominal malignancy by detection and subsequent biopsy of small lesions. Laparoscopic ultrasound can replace the lack of tactile sensitivity in laparoscopy, thus enabling the detection of non-superficial lesions.