Objective To investigate the clinical value of shear wave elastography (SWE) and multi-parameter model in the diagnosis of esophageal varices (EV) in patients with HBV-related hepatocellular carcinoma. Methods A total of 180 patients with hepatocellular carcinoma diagnosed by pathology were enrolled. The results of gastroscopy were used as the standard. According to the presence or absence of EV and its severity, 50 patients (EV0 group) and 69 patients with mild EV were included. (EV1 Group), 33 patients with moderate EV (EV2 group) and 28 patients with severe EV (EV3 group). SWE was used to measure liver stiffness and spleen stiffness; laboratory tests were performed to obtain aspartate aminotransferase (AST) levels, platelet counts, and aspartate aminotransferase/platelet ratio index (APRI) and platelet count/ The spleen long diameter were calculated. ratio (PSR) compares the differences of the above parameters in each group. The correlation between liver stiffness, spleen stiffness, APRI, PSR and EV was analyzed. Liver stiffness, spleen stiffness, APRI and PSR were used to predict the receiver operating characteristic (ROC) curve at different EV levels, and the diagnostic efficacy was calculated. Spearman correlation analysis of factors affecting spleen stiffness values. Results The spleen stiffness, APRI and PSR were statistically significant (P<0.05). There was a significant positive correlation between spleen stiffness and EV (r=0.656, P<0.05). There was a moderate positive correlation between liver stiffness, APRI and PSR and EV (r=0.524, 0.431, 0.363, P<0.05). Spleen stiffness diagnosis EV ≥ 1 (EV1, EV2 and EV3), EV ≥ 2 (EV2 and EV3), the area under the ROC curve of EV = 3 was 0.854, 0.815, 0.821, respectively, which was significantly higher than the diagnosis of liver stiffness, APRI and PSR. efficacy. Spearman correlation analysis showed that spleen stiffness was positively correlated with total bilirubin, age and spleen long diameter values (r=0.190, 0.329, 0.464, P= 0.004, 0.000, 0.004), and negatively correlated with PLT (r=- 0.455, P = 0.001). Conclusion The spleen stiffness value measured by SWE combined with multi-parameter model APRI and PSR can non-invasively diagnose the EV degree of HBV-related hepatocellular carcinoma patients, and has important clinical value.