Gastrointestinal (GI) bleeding remains a major cause of emergency hospitalizations worldwide, demanding rapid endoscopic intervention for diagnosis and hemostasis. However, in countries with vast geographic distances and limited healthcare infrastructure such as Mongolia, timely endoscopy is often unavailable for non-transportable patients in rural areas. This study evaluates the clinical outcomes and feasibility of mobile, on-site emergency endoscopy in such patients, highlighting its potential to reduce mortality and improve accessibility.

Between 2019 and 2024, a mobile endoscopy team conducted 928 emergency visits across 15 provinces and 6 districts in Mongolia. Of these, 796 cases involved gastrointestinal bleeding. All procedures were performed using portable endoscopy systems in accordance with international emergency protocols. Data on the source of bleeding, hemostasis success, mortality, and regional distribution were retrospectively analyzed.

Among 796 GI bleeding cases, 82% were upper GI, 7% were lower GI, and 11% had mixed or unidentified sources. The leading etiologies were esophageal varices (64%), fundal varices (11%), and gastric ulcers (21%).

Endoscopic hemostasis was achieved in 98% of cases. Despite the severity of presentation, the overall mortality rate was 1.9% (n = 19) — all deaths occurred in patients with variceal bleeding (p = 0.015). Notably, 79% of deaths occurred in urban patients, whereas rural cases had significantly better outcomes (p = 0.0012).
Timely intervention within 12–24 hours was associated with improved hemodynamic stability and reduced transfusion requirements.

Mobile, on-site emergency endoscopy is a feasible and life-saving strategy for managing GI bleeding in non-transportable patients within resource-limited and remote regions. Early intervention substantially decreases mortality and eliminates the need for high-risk transfers. Establishing a national emergency endoscopy network, supported by public investment, mobile infrastructure, and standardized clinical criteria, could ensure equitable access to critical care across Mongolia.