Background: Development of oesophageal varices is a major complication that may occur in up to 90% of cirrhotic patients. The endoscopic screening is an invasive procedure. This is why the selection of patients with large oesophageal varices at high risk for bleeding has become an issue of growing importance. In this respect, several clinical, biochemical, ultrasonographic and elastrogarphic (transient elastography-TE) methods have been proposed (and some of them validated) as noninvasive alternatives to endoscopy. Objectives: It was to evaluate transient elastography by fibroscan in the prediction and determination of the grade of esophageal varices in cirrhotic patients due to chronic hepatitis c virus (HCV) infection with or without bilharziasis. Patients and Methods: Sixty Egyptian patients with body mass index (BMI) <35, no history of: upper gastro-intestinal tract (GIT) bleeding, hepatocellular carcinoma, moderate and tense ascites or any other cause of liver cirrhosis. The patients were divided into two groups: Group I included thirty patients with liver cirrhosis due to HCV infection only. Group II included thirty patients with liver cirrhosis due to HCV infection associated with bilharziasis. The patients were subjected to: 1) Thorough history taking. 2) Detailed clinical examination. 3) Laboratory tests. 4) Abdominal ultrasound. 5) Rectal snip for diagnosis of bilharziasis. 6) Upper gastrointestinal endoscopy. 7) fibroscan. Results: Regarding fibroscan in both groups, the mean values of fibroscan were lower in patients without esophageal varices than patients with esophageal varices or with large esophageal varices with statistically high significant differences (p<0.01). Regarding fibroscan in group I, the mean values of fibroscan were lower in patients without esophageal varices than patients with small esophageal varices with statistically high significant differences (p<0.01). But in group II, the mean values of fibroscan were lower in patients without esophageal varices than patients with small esophageal varices with statistically non significant differences (p > 0.05). In both groups, the mean values of fibroscan were lower in patients with small esophageal varices than patients with large esophageal varices with statistically non significant differences (p > 0.05). Conclusion: fibroscan is valuable in predicting the presence of esophageal varices and large esophageal varices in patients with post HCV liver cirrhosis with or without bilharziasis but couldnot predict the grade of esophageal varices.