This study recommended that all cirrhotic patients should be screened for presence of esophageal varices (OV). In developing countries, Endoscopy screening of all cirrhotic patients is a large burden and patients’ compliance decreases gradually.  The aim of this study was to evaluate right lobe diameter of the liver /serum albumin ratio and other parameters as platelet count /spleen diameter, portal vein velocity and hepatic artery resistive index for accurate non-invasive prediction of esophageal varices (OV).  100 cirrhotic patients were enrolled in the study. All patients were subjected to full history taking, thorough clinical examination, complete blood picture, complete liver functions, prothrombin time &activity, ultrasound on abdomen &pelvis, doppler US and upper endoscopy. Right lobe diameter of the liver /serum albumin at a cutoff value≥4.92significantly predicted presence of OV with 63.61%sensitivity, 97.67%specificity, PPV 97.3%, and a NPV 66.7%. A platelet count /bipolar spleen diameter cutoff value<570 significantly predicted presence of OV with 77.19%sensitivity, 93.02%specificity, a PPV of 93.6%, and a 75.5% NPV. Portal vein velocity could significantly predict OV at a cutoff value≤12cm/sec with 85.96% sensitivity, specificity 86.05% PPV 89.1%, and NPV 82.2. Hepatic artery resistive index was also significantly predictive for OV presence with 70.18%sensitivity, 100% specificity, 100%PPV and a 71.7% NPV at a cutoff value>0.76.  Right liver lobe diameter /serum albumin, platelet count /spleen diameter and the Doppler US parameters; portal vein velocity and hepatic artery resistive index are easy to perform, inexpensive and can predict the presence of esophageal varices.

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