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Introduction The Baveno VII consensus stratifies the risk of esophageal varices needing treatment (VNT) using non-invasive parameters, aiming to reduce unnecessary screening endoscopies in patients with cirrhosis. This study evaluated the diagnostic performance of liver stiffness measurement by transient elastography and platelet count, as defined by the Baveno VII criteria, for predicting esophageal varices and VNT.Methods This cross-sectional diagnostic accuracy study included 165 patients with clinically or radiologically confirmed cirrhosis who underwent transient elastography (FibroScan) and upper gastrointestinal endoscopy. Esophageal varices were classified as none, small (<5 mm), or large (≥5 mm). Liver stiffness measurement, platelet count, and liver biochemistry were analyzed, and the diagnostic performance of liver stiffness and Baveno VII thresholds for predicting any varices and varices needing treatment (VNT) was assessed using receiver operating characteristic analysis.Results Liver stiffness increased with variceal size, from a median of 9.7 kPa in patients without varices to 22.3 kPa in those with small varices and 38.6 kPa in those with large varices (p<0.001). Platelet counts declined accordingly, with mean values of 224 × 10 9/L, 149 × 109/L, and 129 × 109/L, respectively (p<0.001). The area under the receiver operating characteristic curve for liver stiffness measurement was 0.90 for detecting any varices and 0.83 for large varices. Application of the Baveno VII rule-out criteria (LSM ≤15 kPa and platelet count ≥150 × 109/L) identified 59 patients (35.8%) in whom endoscopic screening could be deferred; three patients (5.1%) with large varices were misclassified, corresponding to a missed varices-needing-treatment rate of 5.3% and a negative predictive value of approximately 95%. The rule-in threshold (LSM ≥25 kPa) demonstrated high specificity for identifying significant varices, although positive predictive value was moderate.Conclusions The Baveno VII non-invasive criteria accurately predicted esophageal varices and varices needing treatment in patients with cirrhosis. Liver stiffness measurement and platelet count stratified risk, allowing safe deferral of endoscopy in low-risk patients and more targeted use of endoscopic resources.