Background: Non-invasive parameters for the prediction of large esophageal varices among patients with liver cirrhosis is of greatest importance as it may decrease both the medical and economic load related to screening.  The aim of this study is to evaluate platelet count/spleen diameter ratio as a non-invasive predictor of high-risk esophageal varices. Patients and methods: This observational cross-sectional study included forty eight cirrhotic patients underwent screening endoscopy for EV. All participants were subjected to full history taking, clinical examination, laboratory investigations, abdominal ultrasonography (US) and upper gastrointestinal endoscopy and EV grading classification according to AASLD practice guidelines criteria. Calculation of spleen bipolar diameter and platelet count /bipolar spleen diameter ratio for all patients and its diagnostic accuracy was done. Results: The patients were divided into two groups according to esophageal varices;risky group, included twenty four patients with large risky varices and non-risky group, included twenty four patients with small non risky varices. Compared to patient with non-risky varices, patient with large risky varices had a significant higher mean abdominal US spleen bipolar diameter and lower mean platelet count/spleen diameter ratio. Platelet count/spleen diameter ratio at cut off point equal to or less than 809.45 had sensitivity and specificity  95.8% (for each) to differentiate between high and low risk groups with area under ROC 0.99.Furthermore, spleen bipolar diameter ≥138.7 mm cutoff point had sensitivity of 95.8% and specificity 62.5% in detecting high risky varices with total accuracy was 79.2% and area under ROC 0.94.  Conclusions: The platelet count/spleen diameter ratio and spleen bipolar diameter in cirrhotic patients may be proposed as safe and reproducible tools to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.