Training-Time Optical Priors for Wireless Capsule Endoscopy Classification: Hemoglobin-Aware Input Fusion with Cross-Vendor Evaluation
Authors: Chengshuai Yang, Lei Xing, Keyaan Zawad Alam, Gregory Entin, Roopa Vemulapalli, Lisa Casey, Raiyan Tripti Zaman
Organizations: Department of Biomedical Engineering, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, TX, USA · Department of Radiation Oncology, Stanford University, Stanford, 94305, CA, USA · Coppell High School, Coppell, TX, USA · VELVETECH, LLC, USA · Division of Digestive and Liver Diseases, Clements University Hospital, Dallas, TX, USA · Internal Medicine, Division of Digestive and Liver Diseases, Parkland Hospital, Dallas, TX, USA · Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
Abstract
Gastrointestinal cancers cause approximately 3.4 million deaths annually, and early small-bowel lesions are easily missed at wireless capsule endoscopy (WCE). RGB-trained WCE classifiers conflate hemoglobin contrast with bile staining and illumination falloff, limiting sensitivity to small-vessel vascular findings such as Lymphangiectasia. We introduce a physics-informed framework that injects an analytic, Monte-Carlo-inspired hemoglobin prior into a standard classifier purely at training time -- to our knowledge the first use of an explicit optical light-transport prior in WCE classification. On Kvasir-Capsule (47,238 frames, 43 patients, 11 evaluable classes; patient-disjoint split) we evaluate, across six seeds against an RGB-only EfficientNet-B0 baseline, a five-channel input-fusion variant feeding the prior alongside RGB, a distillation variant that runs on plain three-channel RGB at inference, and a three-stream extension adding a temporal Transformer and an autoencoder-residual stream; we replicate across ResNet-18 and ConvNeXt-Tiny and assess cross-vendor zero-shot transfer on the public Galar cohort. Input fusion lifts cross-seed macro-AUC from 0.760 to 0.783 (5/6 seeds positive); distillation reaches 0.773; the three-stream model reaches 0.804 (+0.044 over baseline, paired DeLong p < 0.0001). Lymphangiectasia AUC rises from 0.238 to 0.337, sign-consistent across all six seeds. A four-variant ablation reveals a parameterization-mechanism boundary: only the spatial-channel form lifts. Cross-vendor zero-shot on Galar retains about 60% of the lift. The distillation variant deploys on plain RGB with a free interpretability heatmap, and we release GalKva-2026, a paired cross-vendor benchmark.
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) classification is typically evaluated within a single dataset, yet clinical deployment demands robustness across acquisition sources, labeling policies, and patient populations. We examine this gap using Kvasir-Capsule, Capsule Vision 2024 (CV2024), and a shared-label subset of Galar. We fine-tune a suite of general-domain pretrained backbones on the official Kvasir-Capsule folds under a standardized protocol and evaluate the same checkpoints on two non-source targets within a documented shared-label decision space. We find that the predictive value of in-domain ranking is target-dependent: Kvasir-Capsule ranking aligns more closely with Galar than with CV2024, while the two non-source targets agree only weakly. Consequently, the strongest in-domain backbone leads on one target yet falls to mid-pack on the other, and no single evaluation target reliably predicts the others. A second CV2024-trained configuration set reproduces this target-dependent instability. We conclude that capsule endoscopy model selection should report cross-target ranking stability rather than peak single-dataset performance.
Wireless Capsule Endoscopy (WCE) enables non-invasive visualization of the gastrointestinal tract, but its miniaturized optics, sensor limitations, and wireless transmission constraints result in low-resolution images with reduced visibility of diagnostically important structures. This paper proposes CEM-TUDASR, a computationally efficient unsupervised Transformer-based super-resolution framework for WCE image enhancement without paired low-resolution (LR) and high-resolution (HR) training data. A domain-adaptive degradation network synthesizes realistic WCE-like LR images from HR conventional endoscopy images, reducing the domain gap and enabling effective unpaired learning. The SR generator integrates Deep Attention Blocks (DABs) and a Fusion Attention Block (FAB) to capture long-range contextual dependencies and fine local structures while preserving perceptual and structural fidelity. The model is trained on a curated dataset derived from Kvasir Capsule and evaluated on KID and GIANA for cross-dataset generalization. No-reference quality metrics, including BRISQUE, PIQE, NIQE, and the domain-specific EndoQM, show that CEM-TUDASR consistently outperforms existing unsupervised SR methods. Qualitative results further demonstrate improved restoration of mucosal textures, vascular patterns, and clinically relevant anatomical details. Cross-domain experiments on retinal images additionally demonstrate the adaptability of the framework. With only 2.67 million parameters and 169.94 GFLOPs, CEM-TUDASR achieves high-quality reconstruction while maintaining computational efficiency, making it suitable for resource-constrained clinical and embedded endoscopic applications.