EndoFSA: Endoscopic Few-Shot Image Generation via Rank-Constrained Parameter Adaptation

Developing foundation generative models for endoscopy is limited by the gap between natural and clinical images and the computational cost of training large Diffusion Transformers. Although representation alignment has improved efficiency in general computer vision, its role within the highly specialized endoscopic image space remains unclear. We introduce REVEAL (Representation-driven Endoscopic Visual Embedding Alignment), the largest generative foundation model for endoscopy to date, trained on GastroNet-5M (GN-5M), a multicenter dataset of 5 million endoscopic frames. Instead of depending on out-of-domain priors, REVEAL employs encoders pretrained directly on the endoscopic distribution to align diffusion latents with domain-specific visual features, preserving fine textures and intricate anatomical structures. Beyond image generation, REVEAL also serves as a powerful feature extractor; in multiple benchmarks, it delivers performance that is competitive with, and in several cases exceeds, endoscopic foundation models such as EndoViT and Endo-FM, specifically tuned for classification tasks, while demonstrating strong representation robustness under realistic imaging corruptions. REVEAL produces high-fidelity images and maintains robust structural coherence in latent-space edits such as inpainting and outpainting. This high-capacity backbone lowers the computational threshold for building specialized clinical tools, offering an open, versatile foundation for conditional synthesis, segmentation, and out-of-distribution detection in future intelligent gastroenterology systems.

The major limitations of gastrointestinal (GI) endoscopy AI systems arise from a shortage of annotated data, strict privacy policies, and significant bottlenecks in conventional model fine-tuning. Such limitations impede the successful application of sophisticated AI models in clinical practice, particularly affecting the reliability and scalability of diagnosis. In this paper, we present a dual-pipeline PEFT model that addresses two fundamental problems: medical Visual Question Answering (VQA) and the generation of privacy-preserving synthetic data. For clinical VQA, we adopt the Florence-2 vision-language model. Leveraging PEFT enhances model interpretability while substantially reducing the computational cost of training. Simultaneously, we employ Low-Rank Adaptation (LoRA) with Stable Diffusion 2.1 to generate high-quality GI images that enhance training databases without violating patient privacy. This research utilized the Kvasir-VQA dataset. Our Florence-2 VQA model achieved ROUGE-1 of 0.92, ROUGE-L of 0.91, and BLEU score improvements from 0.08 to 0.24. Fine-tuning on private datasets consistently showed better results than fine-tuning on public datasets. The rank-4 LoRA synthesis achieved optimal performance with a fidelity score of 0.290, an agreement score of 0.730, and a Frechet BiomedCLIP Distance (FBD) of 1450, reducing computational costs by almost 90 percent. This framework improves the clinical potential of AI in GI endoscopy. Compared to FLUX, MSDM, and Kandinsky 2.2, our model demonstrates superior FBD and strong semantic alignment. While other models lead in Fidelity or Agreement, our lower FBD indicates better image-text coherence. These results establish our approach as a robust solution for enhancing VQA and synthetic data generation in clinical AI.

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.