The possibility of identifying cirrhotic patients with esophageal varices by noninvasive means is attractive, because it would allow for the restriction of the performance of screening endoscopy to patients at high risk of having varices. Over the years, several studies addressing this issue have been performed with little success. The recently proposed platelet count/spleen diameter ratio appears to be the best noninvasive predictor of esophageal varices developed so far. However, the available evidence is not yet sufficient to allow for the modification of the current policy of screening cirrhotic patients by endoscopy at the time of diagnosis to detect varices.