This study aimed to evaluate the impact of introducing a specialized endoscopist and endoscopy nurse into a rural regional hospital in Mongolia on the accessibility, quality, and cost of gastrointestinal endoscopic services. Specific objectives included assessing changes in service availability, procedure volume, cost-effectiveness for patients, and early clinical outcomes following the introduction of the new services in March 2025.
A mixed-methods study was conducted at Kh. Sharav Regional Diagnostic and Treatment Center, Umnugovi Province.
Quantitative component:Procedure volumes for 2024 (before deployment) and January–September 2025 (after deployment) were compared. Cost analyses were performed using patient out-of-pocket expenditures for travel, accommodation, service fees, and additional costs in Ulaanbaatar versus local service use. Procedure types evaluated included gastroscopy, colonoscopy, bronchoscopy, gastric and colonic polypectomy, hemostasis, esophageal variceal ligation, and foreign-body removal.
Qualitative component:Twenty staff members (12 physicians, 8 nurses) completed a structured satisfaction survey assessing perceived workload changes, usefulness of new services, and overall satisfaction. Additionally, detailed case summaries were reviewed for 20 patients who underwent local therapeutic endoscopic procedures. Ethical approval was obtained at the institutional level, and no identifiable patient data were included.
Service accessibility and procedure volume:Introduction of specialized staff resulted in significant expansion of services. Gastroscopy increased from 945 (2024) to 1,315 (2025). Colonoscopy rose from 3 to 117, bronchoscopy from 0 to 17, and several therapeutic procedures (e.g., gastric/colonic polypectomy, hemostasis, variceal ligation) were performed locally for the first time. A total of 37 patients received therapeutic care locally instead of referral to Ulaanbaatar.
Cost reduction:Local service provision reduced average patient expenditure by 3–8 times depending on the procedure.For example:• Esophageal variceal ligation: 1,900,650 MNT locally vs. 6,694,200 MNT in Ulaanbaatar• Hemostasis for gastric bleeding: 3,151,500 MNT vs. 7,771,500 MNT• Foreign-body removal (esophagus/stomach): 0 MNT vs. 2,640,000 MNTTotal patient cost savings for 37 cases amounted to 22,073,550 MNT.
No patients required referral to Ulaanbaatar for gastrointestinal bleeding management after March 2025. No deaths due to GI hemorrhage were recorded during the study period.
Clinical outcomes:All 20 documented therapeutic cases—including gastric ulcer bleeding managed by clipping, gastric polypectomies, variceal ligation, and foreign-body removals—showed complete recovery with no complications or technical difficulties.
Staff perceptions:All staff (100%) agreed that the newly introduced endoscopic procedures were beneficial for patients. Overall satisfaction was 100% (“satisfied” or “very satisfied”). Only 30% reported increased workload, while 60% perceived improved capacity.
Deploying specialized endoscopy personnel to a rural regional hospital significantly improved service accessibility, enabled provision of advanced diagnostic and therapeutic procedures, and substantially reduced patient costs. The elimination of referrals for endoscopic management of gastrointestinal bleeding and the absence of mortality during the study period demonstrate early clinical benefit. The initiative also contributed to capacity building among local healthcare providers and serves as a scalable model for strengthening specialized services in rural Mongolia. Expanding deployment of specialized professionals has strong potential to enhance equity, quality, and continuity of care in low-resource settings.