Gastroesophageal varices are consequences of portal hypertension, and in patients with cirrhosis, variceal bleeding is a significant cause of death and other related morbidities [1]. In Egypt, the incidence of esophageal varices in hepatitis C virus (HCV) patients with liver cirrhosis are pretty high, reaching about 62%, and the incidence of large varices reaches 47% [2].

Portal pressure has conventionally been measured by evaluating the hepatic venous pressure gradient (HVPG), and values of >10 mmHg are associated with a risk of developing high-risk gastroesophageal varices [3]. Although the occurrence and size of varices correlate well with the HVPG, its measurement requires an invasive procedure, and it is not widely used [4].

Screening for gastroesophageal varices by endoscopy is recommended for all patients with cirrhosis, and identification of varices enables treatment to prevent bleeding. However, routine endoscopic screening of all patients with cirrhosis has prohibitive healthcare costs and places a remarkably high burden on endoscopy units. In addition, many patients are not compliant, refuse repeated screening endoscopy, and consider it an unpleasant invasive procedure [5]. There is still a need to detect esophageal varices using simple, non-invasive parameters [6]. As part of the vast nationwide Egyptian program for managing HCV, many screening endoscopic examinations were conducted in viral hepatitis treatment centers affiliated to the Egyptian National Committee for Control of Viral Hepatitis (NCCVH). Endoscopic screening for varices was one of the treatment perquisites for patients with a documented or probable diagnosis of liver cirrhosis in national HCV management guidelines [7], [8], [9].

Non-invasive methods for assessing cirrhosis, such as using platelet count, aspartate aminotransferase (AST): alanine aminotransferase (ALT) ratio (AAR), AST: platelet ratio index (APRI), Lok index, Forn’s index, and transient elastography (TE), have been validated for determining the stage of liver fibrosis and subclinical cirrhosis, and have gained popularity because they are simple and reproducible [10], [11]. Serum non-invasive markers were found to be helpful in initially determining patients with cirrhosis and low risk of having varices and in reducing the number of performed screening endoscopies. However, the available evidence was insufficient to replace endoscopy with non-invasive markers in most patients [11]. Baveno VI guidelines suggested avoiding screening endoscopy in patients with cirrhosis, liver stiffness measurement (LSM) <20 kPa with a platelet count of >150,000/µL, based on the high specificity of the combination of these markers in excluding risky varices that need intervention [12].

This retrospective study aimed to assess the validity of different non-invasive parameters, including the Baveno VI criteria and the expanded Baveno VI criteria, to predict the presence of esophageal varices in Egyptian patients with HCV-related cirrhosis.