Anatomical Landmark-Guided Deep Reinforcement Learning for Autonomous Gastric Navigation

Autonomous endoscopic navigation can reduce clinicians' operational burden, yet robust control remains challenging due to tissue deformation, transient occlusions, and rapidly changing viewpoints. Existing learning-based policies typically predict actions from current observations without explicitly modeling future dynamics, limiting their robustness and reliability in safety-critical settings. World Action Models (WAMs) offer a promising alternative by coupling predictive visual dynamics with action generation, but extending them to robotic endoscopy remains challenging due to limited training data, restricted viewpoint diversity, deformable anatomy, and high inference latency. We present EndoWAM, which is, to our knowledge, the first WAM for generalizable robotic endoscopic navigation. EndoWAM introduces future grounding, which predicts task-relevant target regions in future observations from intermediate denoising features of a video world model. Specifically, EndoWAM couples a lightweight diffusion transformer for future target-region prediction with a discrete action expert through a shared predictive representation. This design injects target-aware supervision into predictive dynamics modeling, improving robustness to visual degradation and viewpoint changes while enabling real-time control in a single denoising pass. We further introduce EndoMotion, a robotic endoscopic motion dataset spanning three anatomically distinct procedures: ureteroscopy, esophagoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). EndoWAM consistently outperforms all baselines and alternative grounding strategies, while demonstrating strong zero-shot generalization to unseen viewpoints, environments, and targets. These results establish EndoWAM as a predictive, target-grounded framework for accurate, generalizable, and long-horizon navigation in visually constrained endoscopic environments.

Endoscopic retrograde cholangiopancreatography (ERCP) demands precise endoscopic navigation and stable biliary cannulation within a narrow monocular field characterized by specular reflections, partial occlusions, and frequent tissue contact. Although recent robotic systems and vision-based assistance techniques improve operator ergonomics and provide perceptual cues, their performance degrades under pronounced anatomical variability and safety-critical visual artifacts, which hinders reliable autonomy in cannulation-grade procedures. Here, we present BiliVLA, a scene-aware Vision-Language-Action (VLA) framework that formulates biliary endoscopic navigation as an instruction-conditioned visuomotor learning problem. Given an endoscopic observation and a stage-specific language instruction, BiliVLA jointly predicts the target category, a grounded bounding box, and a discrete three-degree-of-freedom (3-DoF) motor command for a continuum endoscope. The proposed framework incorporates scene-aware supervision to improve semantic target consistency and safety-aware recovery supervision to induce conservative retreat behaviors under luminal wall contact. A key component of BiliVLA is a two-stage training paradigm that combines grounding-enhanced supervised fine-tuning (SFT) with Group Relative Policy Optimization (GRPO), thereby improving action reliability and decision consistency during closed-loop navigation. Across three ERCP subtasks, BiliVLA achieves the best overall performance in physical phantom experiments, with a total mIoU of 0.9625, an overall action precision of 91.96%, and an overall success rate (SR) of 84.85%. These results indicate that integrating semantic grounding, scene-aware learning, and reward-guided optimization strengthens perception--action alignment and enables more robust autonomous biliary endoscopic navigation.

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.