Noninvasive prediction of esophageal varices extremely high mortality rate (1-3). Therefore, the pre- vention of variceal bleeding is an important goal in man- agement patients with liver cirrhosis. Universal endo- scopic screening of EVs is recommended in conjunction with primary prophylaxis in patients who are at high risk of variceal bleeding (4, 5). But, this screen is invasive, and many patients will not have varices, rendering this method cost-ineffective. Thus, noninvasive diagnosis of portal hypertension may be useful (2). Recently, several studies have attempted to identify the variables that can predict the presence of EVs—even large EVs—noninvasive- ly, examining various biochemical, clinical, and ultra- sonographic parameters alone or in combination, with promising results overall (6-9). Most such variables, however, have several limitations, which has hindered the wide application of these results. Early studies were retrospective and were performed in a specific subgroup of patients—those who were going to be placed on a wait list for liver transplantation (8, 10-14); thus, the study groups lacked homogeneity and the wide representation of the cirrhotic population that is seen in clinical practice. Further, in patients with chronic liver disease, although the presence of thrombocytopenia is due primarily to portal hypertension (15), thrombocy- topenia can depend on other factors, such as shortened mean platelet lifetime, decreased thrombopoetin pro- duction, and the myelotoxic effects of alcohol or hepati- tis viruses (16); thus, the autoimmune profile and bone marrow aspirate should be assessed for greater accuracy before conclusions can be made on the final data that thrombocytopenia is owing to liver cirrhosis. Finally, there has been a lack in uniformity in the classi- fication and diagnosis of EVs in previous studies (8, 10-14), in which EVs were not categorized by a single endosco- pist or in the same endoscopy unit. Moreover, their focus on patients with large EVs might have led to the omission of an important subset of patients who required medical counseling; thus, the analysis of the presence or absence of EVs might prevent data from being misinterpreted and allow results to be generalized (15). The platelet count:spleen diameter ratio, proposed by Giannini et al. (15), appears to be one of the best noninvasive predictors of EVs that have emerged (17). Objectives In this prospective study, we evaluated the platelet count:spleen diameter ratio in 175 consecutive unselect- ed Egyptian cirrhotic patients—with varying ethnicities and clinical presentations and poor nutritional status, many of whom had a viral etiology—in predicting EVs. Patients and Methods Eligible patients This study included 175 consecutive patients with liver cirrhosis due to hepatitis C virus. Liver cirrhosis was di- agnosed by physical, laboratory, and radiological evalua- Abu El Makarem MA et al. 279 tions. Diagnosis was confirmed by histological examina- tion of Tru-cut needle-isolated liver biopsy for patients with Child-Pugh class A. After written consent was ob- tained, the participants underwent upper GIT endoscopy in our endoscopy unit, Minia University Hospital, be- tween April 2008 and March 2010. The exclusion criteria were: active variceal bleeding at admission, a history of endoscopic variceal sclerotherapy or band ligation, tran- sjugular intrahepatic portosystemic stent shunt place- ment, a history of surgery for portal hypertension, medi- cation use for primary prophylaxis of variceal bleeding, alcohol abuse, and thrombocytopenia due to causes other than hypersplenism. Other complications of liver cirrhosis were not exclusion criteria, although they were recorded. Informed consent The study protocol was approved by the Institutional Ethics Committee of the School of Medicine, Minia Uni- versity, Egypt, and all patients gave their informed con- sent to participate. The study was conducted in accor- dance with the ethical guidelines of the 1975 Declaration of Helsinki and the International Conference on Harmo- nization Guidelines for Good Clinical Practice. Clinical and Laboratory Assessment At the time of the upper endoscopy, a history was taken and a clinical examination was performed, with special emphasis on the stigmata of chronic liver disease and a careful abdominal examination. After hospital admis- sion, venous blood was drawn to determine the complete blood count, prothrombin time and concentration, liver function, and renal function. In thrombocytopenic pa- tients (platelets < 140,000/cmm), anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and gam- ma-globulin levels were measured and bone marrow as- piration was performed to exclude causes of thrombocy- topenia other than portal hypertension. Imaging Study Abdominal ultrasonography: Cirrhosis was diagnosed per the criteria of Tchelepi et al. (18). Maximum bipolar spleen diameter was measured by ultrasonography and expressed in millimeters per Lamb et al. (19). The platelet count/ bipolar splenic diameter ratio was calculated for all patients. Duplex study of the portal vein: Mean portal blood flow velocity (MPBV) was measured in the portal vein trunk per Mori Yasu et al. (20) and expressed in the Duplex Doppler system as V mean. After these evalua- tions were completed, all cirrhotic patients were classi- fied per Child-Pugh's criteria (21), and their scores were calculated. Upper Endoscopy Patients were evaluated for the presence of EVs, gas- Hepat Mon. 2011;11(4):278-284