Divide-then-Diagnose: Weaving Clinician-Inspired Contexts for Ultra-Long Capsule Endoscopy Videos
Authors: Bowen Liu, Li Yang, Shanshan Song, Mingyu Tang, Zhifang Gao, Qifeng Chen, Yangqiu Song, Huimin Chen, +1 more
Organizations: 1The Hong Kong University of Science and Technology · 2Renji Hospital, Shanghai Jiao Tong University School of Medicine
Abstract
Capsule endoscopy (CE) enables non-invasive gastrointestinal screening, but current CE research remains largely limited to frame-level classification and detection, leaving video-level analysis underexplored. To bridge this gap, we introduce and formally define a new task, diagnosis-driven CE video summarization, which requires extracting key evidence frames that covers clinically meaningful findings and making accurate diagnoses from those evidence frames. This setting is challenging because diagnostically relevant events are extremely sparse and can be overwhelmed by tens of thousands of redundant normal frames, while individual observations are often ambiguous due to motion blur, debris, specular highlights, and rapid viewpoint changes. To facilitate research in this direction, we introduce VideoCAP, the first CE dataset with diagnosis-driven annotations derived from real clinical reports. VideoCAP comprises 240 full-length videos and provides realistic supervision for both key evidence frame extraction and diagnosis. To address this task, we further propose DiCE, a clinician-inspired framework that mirrors the standard CE reading workflow. DiCE first performs efficient candidate screening over the raw video, then uses a Context Weaver to organize candidates into coherent diagnostic contexts that preserve distinct lesion events, and an Evidence Converger to aggregate multi-frame evidence within each context into robust clip-level judgments. Experiments show that DiCE consistently outperforms state-of-the-art methods, producing concise and clinically reliable diagnostic summaries. These results highlight diagnosis-driven contextual reasoning as a promising paradigm for ultra-long CE video summarization.
Wireless capsule endoscopy (WCE) enables non-invasive visual assessment of the small bowel, but its clinical utility is constrained by the large volume of frames generated per examination and the difficulty of recognising subtle abnormalities under highly variable imaging conditions. Existing learning-based approaches for WCE are predominantly vision-only, often confined to narrow pathology sets, and show limited transfer across datasets and centres. To address these limitations, this study introduces CapCLIP, a domain-specific vision-language representation learning framework for WCE. CapCLIP aligns capsule endoscopy frames with clinically grounded textual descriptions derived from standardised nomenclature and pathology-aware caption templates, thereby learning embeddings that are both semantically informed and transferable. The proposed framework is evaluated against relevant open-source vision and vision-language foundation models under strict zero-shot conditions using unseen WCE datasets. Evaluation covers three downstream tasks: K-nearest neighbour classification, CLIP-style image-text classification, and text-to-image retrieval. Across these settings, CapCLIP consistently outperforms the compared baselines, with particularly strong gains in zero-shot image-text classification and cross-modal retrieval on out-of-distribution datasets. The results indicate that language-guided representation learning can improve both generalisation and semantic interpretability in WCE analysis. These findings position CapCLIP as a step toward foundation models tailored to capsule endoscopy and support the use of language-grounded WCE analysis.
Video Capsule Endoscopy (VCE) is a non-invasive medical examination that allows for the observation of the small intestine, which is otherwise difficult to access. A fundamental challenge persists in the form of their limited size in order to still be swallowable. The resulting restricted battery capacity, however, contradicts with the power-intensive nature of image capture and transmission. Therefore, we propose CapsuleMotion, a patient-specific dynamic capsule behavior that utilizes the available energy in a goal-oriented manner to increase the likelihood of a complete screening of the gastrointestinal tract. By investigating and combining metrics from the on-device image compression, CapsuleMotion predicts the motion between two successive frames. The camera's frame rate will be modified in accordance with the predicted magnitude of motion. Furthermore, prior to entering the small intestine, the capsule operates in a low power mode with a significantly reduced frame rate. In this mode, the LocalizationNet is employed to determine the current organ, provided that motion was predicted. The proposed framework is evaluated on the Rhode Island VCE dataset and deployed on an ultra-low power single-core RISC-V demonstrator with an integrated hardware accelerator. CapsuleMotion demonstrated the capability to reduce electric energy consumption by up to 20.66% in comparison with conventional capsules that lack a dynamic frame rate. Additionally, the accuracy of detecting the entry point of the small intestine has been improved.
Video Capsule Endoscopy (VCE) poses a challenging multi-label temporal classification problem, requiring simultaneous localization of 8 anatomical regions and detection of 9 pathological findings across tens of thousands of frames. We present GALAR-TemporalNet v2, a hierarchical temporal model that addresses three core challenges: extreme class imbalance, long-range temporal dependencies, and pathology--anatomy entanglement. Our architecture combines windowed self-attention for local modeling, a Dual-Graph GCN for global frame relationships, and Bidirectional Mamba for selective boundary context encoding. A novel anatomy prototype residual pathway decouples pathological deviation signals from normal organ appearance, and a frame-level GCN skip connection stabilizes training of visually confusable rare classes. The competition version, GALAR-TemporalNet, achieved an overall mAP@0.5 of 0.2644 and mAP@0.95 of 0.2353 on the RARE-VISION test set. Following the competition, the redesigned GALAR-TemporalNet v2 -- incorporating a restructured pathology branch, refined loss functions, and extended post-processing -- improved these results to mAP@0.5 of 0.3409 and mAP@0.95 of 0.3333.