Aims: There is considerable interest in developing non-invasive models to predict the presence of varices. Liver and spleen stiffness measured by 2dimensional shear-wave elastography (2D-SWE) have become Methods: of interest with good reliability in detecting portal hypertension. In this regard, measurement of the spleen stiffness reflects more accurately the dynamic changes occurring in advanced stages of cirrhosis compared to liver stiffness. We investigated the feasibility of liver- and spleen-SWE for diagnosis of esophageal varices (EV) and detection of high-risk varices. Methods: A total of 191 cirrhotic patients who underwent liver stiffness, spleen stiffness measurements, using 2D-SWE (APLIO 500, Toshiba), along with endoscopic screening were included in this study. Large EV (F2 or F3) or F1 with red colour sign were defined as high-risk EV. Results: EV was present in 130 patients (68.1%). For the presence of EV, the stiffness in liver-SWE had better diagnostic accuracy than the stiffness in spleen-SWE (the area under the receiver-operating characteristic curve (AUC), 0.830 vs. 0.740; Delong test, P=0.050). The best cut-off values in detecting of EV were 14.1kPa: liver-SWE and 16.5kPa: spleen-SWE. Increasing stiffness in spleen-SWE was proportionally correlated with grade of EV, whereas the stiffness in liver-SWE was not. For the presence of high-risk EV, the AUC in spleen-SWE was higher than liver-SWE (0.764 vs. 0.742), but not significantly different. Then, the strongest association was found between high-risk EV and spleen-SWE (r=0.397, P<0.001), with the next strongest association found for Child-Turcotte-Pugh score (r=0.353, P<0.001) and liver-SWE (r=0.314, P<0.001). The best cut-off values for predicting high-risk EV were 14.3kPa: liver-SWE and 22.1kPa: spleen-SWE. Conclusions: In patients with cirrhosis, stiffness measurements obtained by using 2D-SWE have effective non-invasive method for detection of EV. Moreover, the stiffness in spleen-SWE might be a better diagnostic value than liver-SWE for high-risk EV that requires prophylactic therapy.