The presence of esophageal varices in cirrhotic patients is a major complication due to the risk of bleeding with high mortality [1] . The prevalence of esophageal varices in the cirrhotic population is 60% - 80% and the risk of variceal hemorrhage at 1 year is 5% for small varices and 15% for large varices [1] [2] , which justifies upper gastrointestinal (GI) endoscopy at the time of diagnosis of decompensated cirrhosis [3] . In Togo, the prevalence of esophageal varices in the cirrhotic population is 73% [4] . However, in Togo as in other developing countries, digestive endoscopy is not only unavailable in all regions and reserved for referral centers, but is also expensive for most patients [5] [6] . This has motivated the development of non-invasive methods for predicting esophageal varices, including the albumin-serum-ascites gradient, which was evaluated in Togo [7] - [13] . The aim of this study was to evaluate the performance of non-invasive methods such as platelet count, spleen diameter, platelet/spleen diameter ratio and [platelet²/spleen diameter] × AST ratio for the presumptive diagnosis of esophageal varices in cirrhotic patients in Togo.

This was a descriptive and analytical cross-sectional study, with retrospective data collection, involving medical records of all cirrhotic patients followed at Campus Teaching Hospital from January 1, 2019 to January 1, 2021. Included were medical records of cirrhotic patients of both sexes, aged 18 and over, including transaminase assay, blood count, abdominal ultrasound and upper GI endoscopy. Records of cirrhotic patients who had undergone endoscopic band ligation, were on beta-blocker therapy or had portal thrombosis were not included. Data collected included clinical, biological, morphological (ultrasound or abdominal CT scan) and endoscopic data. Esophageal varices were described using the 3-grade classification proposed by the Japanese Society for Portal Hypertension Research [14] . Varices were then classified as:

The main limitation of this study lies in its retrospective data collection nature, which makes it impossible to validate the results obtained. Although thrombocytopenia was associated with the presence of esophageal varices in univariate analysis (p < 0.001), platelet count, at a threshold of 95 giga/l was not a good predictor of the presence of esophageal varices at endoscopy (AUROC = 0.27). In the study by Mahassadi et al. in Côte d’Ivoire [10] , platelet count was a good predictor of esophageal varices (AUROC = 0.768, Se: 80%) for a threshold value of 110.5 giga/l. According to the recommendations of Baveno VII [3] , a threshold of 150 giga platelets /l can be used to identify patients at risk of bleeding complications and who should benefit from primary prophylaxis. The presence of thrombocytopenia correlates with the presence and size of esophageal varices [17] [18] , justifying diagnostic endoscopy when the platelet count is below 150000/mm³, as recommended by Baveno VII [3] . In our study, spleen diameter was an acceptable predictor of esophageal varices (AUROC = 0.63, Se: 70.4%). In line with literature data, spleen diameter is a good diagnostic parameter for esophageal varices and was also correlated with variceal size in several studies [19] - [21] . Splenomegaly, mainly related to portal hypertension in cirrhosis, is therefore not only a good predictor of esophageal varices, but also of variceal size. In the study by Mahassadi et al. [11] , the platelet/spleen diameter ratio was a better predictor of esophageal varices, with high sensitivity and specificity than either platelet count or spleen diameter taken in isolation. As these two parameters are good predictive markers of esophageal varices, their fusion would increase diagnostic cost-effectiveness. However, in our study, the spleen platelet/diameter ratio was not a good predictor of esophageal varices (AUROC = 0.290). This result may be explained by the size of our study population. In univariate analysis, a low [Platelet count²/spleen diameter] × AST ratio correlated with the presence of esophageal varices (p < 0.001). Unlike the study by Mattos et al in Brazil [22] , which found a sensitivity of 95.8% for a threshold of 3 × 10⁸/mm³, this ratio was not predictive of esophageal varices in our study (sensitivity 22%).

Of the four non-invasive methods for predicting esophageal varices evaluated, spleen diameter had the best diagnostic performance and is an acceptable mean of predicting esophageal varices, especially in locations where digestive endoscopy is not accessible. Upper GI endoscopy nevertheless remains the essential tool for the detection of esophageal varices with a view to appropriate prophylactic treatment.