Colonoscopy

False-positive computer-aided detection (CADe) prompts may divert endoscopists' attention during colonoscopy, yet the attentional impact of individual prompts remains unclear. We used event-locked eye tracking to quantify gaze attraction and attention occupation in complementary retrospective and prospective studies. In a retrospective paired-video experiment, 3 senior and 2 novice endoscopists viewed 60 colonoscopy videos with and without CADe. The prospective study recorded gaze during 42 real-time CADe-assisted colonoscopies performed by 9 senior endoscopists. Screened CADe prompts outside expert-annotated lesion windows were classified as false-positive artifact events. False-positive prompts attracted gaze in 48.6% (68/140) of retrospective observations and 65.2% (533/817) of prospective events. Among attraction events with complete recovery, median attention occupation lasted 1000 ms in the retrospective study and 1100 ms in the prospective study. Corresponding median prompt durations were 33 ms and 267 ms, with median time amplifications of 17.55-fold and 5.15-fold, respectively. In paired retrospective comparisons, visible artifact prompts drew gaze closer to the prompted region than did the same-coordinate unassisted reference. Secondary retrospective analyses showed high lesion gaze recognition without and with CADe (98.0% versus 99.0%). First gaze entry into lesion regions occurred 147.8 ms earlier with CADe. Across controlled and real-time clinical settings, false-positive CADe prompts frequently captured gaze, with attention persisting beyond prompt visibility. These findings support considering prompt-related attentional burden in CADe evaluation and design.

Background and Objective: Colonoscopy recording practice preserves text reports and still photographs, while the spatial information already present in the recorded video - where the scope traveled, where a lesion was observed, and whether the same lesion was seen again - is discarded when the procedure ends. This study determines whether a lesion-centered spatial record can be assembled and validated without full-colon 3D reconstruction. Methods: A four-layer hierarchical pipeline was assembled - (1) a global topological map, (2) lesion-level spatio-temporal tracks, (3) on-demand local 3D reconstruction, and (4) persistent lesion identity across repeated observations - and ran end to end on four public videos (two C3VDv2 sequences with ground-truth depth and two full REAL-Colon procedures; 40,245 frames). All components are published, individually validated methods; the contribution is their lesion-centered assembly, linking rules, and evaluation. Results: Revisits, impossible under forward-only mapping by construction, were detected by entry-map Bayesian localization: 5,614 and 4,043 revisit events (56 and 68 distinct nodes) in the two full procedures. Lesion-identity merging at the adopted threshold 0.5 maintained ground-truth purity 1.0 while auto-merging 20 of 231 candidate pairs. The endoscopy-specific geometry engine outperformed a general-purpose foundation model on all metrics (overall absolute relative error (AbsRel) 0.2276 vs. 0.3523). Conclusions: The results are partial but establish a concrete near-term path: revisit detection, lesion identity, and local 3D each returned quantitative, reproducible output without waiting for complete geometric reconstruction; validating the record on clinical data is the next step.

woma is a real-time foundation model for gastrointestinal endoscopy: a network trained without labels on about a million endoscopy frames, from which task models are fine-tuned. We contribute a systematic design for production. Requirements and pass marks were fixed before any run, eight candidates screened under pre-registered rules, self-supervised training taken to a stopping rule, then fine-tuning and deployment optimisation, all on one self-contained library, numbat. We also contribute woma itself with two fine-tuned models, every outcome reported met or missed. Our colonoscopy model finds and outlines polyps, names which colon segment is in view, suggests polyp type and grades bowel preparation. Our gastroscopy model names a station out of 22 protocol sites, flags and outlines lesions, and names one of seven findings. Every number was read on data never seen in training, and shipped weights were chosen on that record. In colonoscopy, 96% of polyps in a six-hospital PolypGen set are found at precision >=0.85, and 19 of 19 polyps across fifteen full REAL-Colon videos at 1.6 false alarms per procedure. In gastroscopy, landmark region is named correctly on 92% of frames from unseen patients, and 37 of 39 held-out neoplasia frames are flagged at specificity 0.91. On one workstation GPU every task runs over 1080p video at about 100 frames per second, faster than PyTorch, ONNX Runtime and TensorRT in all four precision regimes tested. TensorRT comes closest: one pass of our foundation model takes it 3 to 27% longer than ours, and we deliver 6 to 31% more frames per second from frame to results. A second build links no vendor library at all -- our own kernels over Vulkan -- so a site deploys two files and needs no toolkit, no cuDNN and no framework; in f32 it beats the CUDA build on the same card.

Because dense frame-level annotation of colonoscopy videos is costly, we propose WSPolypNet, a weakly supervised framework for polyp localization using only video-level labels. WSPolypNet employs a 3D convolutional neural network trained with video-level supervision to generate class activation maps (CAMs), which identify candidate polyp regions without requiring frame-level spatial annotations. The CAM-derived localization cues are further enhanced using a multi-view strategy and provided to MedSAM2 as point prompts. MedSAM2 then propagates segmentation masks across the video, refining the coarse localization cues according to polyp boundaries. WSPolypNet achieved CorLoc scores of 47.80%, 43.68%, and 35.01% at IoU thresholds of 0.3, 0.5, and 0.7, respectively, compared with 36.87%, 33.72%, and 27.94% in the single-view setting. For small polyps, the multi-view strategy improved CorLoc@0.5 from 16.01% to 30.97%. The framework also achieved a recall of 94.51%. These results demonstrate the potential of weakly supervised spatiotemporal learning to substantially reduce spatial annotation requirements for polyp localization in colonoscopy videos.

Vision-language models remain underused in colonoscopy despite the rich expert descriptions recorded in routine reports. These reports document lesion appearance, size and location but summarise entire procedures rather than caption individual frames, leaving clinical findings only weakly linked to the corresponding images. Here we develop EndoCLIP, a colonoscopy vision-language foundation model trained on 125,756 lesion-level image-text pairs progressively recovered from 280,476 routine colonoscopy records. Across lesion-level image-text retrieval, structured report generation and six multi-centre clinical classification tasks, EndoCLIP outperforms general-purpose and biomedical vision-language encoders in both zero-shot and linear-probe settings. On benign-versus-malignant classification, its linear probe approaches the performance of expert readers in a blinded study involving 12 endoscopists. These results suggest that recovering finding-to-frame correspondence can transform routine documentation into scalable supervision, enabling clinical targets to be specified in language rather than separately annotated for each task.

Conventional colonoscopy remains limited by patient discomfort and procedural risks, motivating research into compliant robotic alternatives. Eversion robots, which advance via pressure-driven tip growth, eliminate sliding friction against the colon wall and offer a less intrusive approach to traversal. However, no existing design simultaneously satisfies all clinical requirements. This paper benchmarks four recent eversion robot architectures against the key anatomical and clinical constraints of colonoscopy, including colon length, minimum luminal diameter, bending angle, and working-channel needs. We identify the central trade-offs each design reveals, particularly the difficulty of integrating steering and payload delivery without sacrificing the soft, low-friction behaviour that makes eversion robots attractive. We then provide design guidance across material selection, steering strategy, and payload delivery, and highlight open problems for clinical translation.

Risk stratification for advanced colorectal polyps typically relies on colonoscopy and/or pathology findings. However, there is growing interest in whether non-invasive features available prior to colonoscopy can help identify patients at higher risk. Such approaches may enhance clinical decision-making by prioritizing surveillance for individuals most likely to harbor high-risk polyps, when colonoscopy resources are limited while potentially reducing unnecessary procedures in lower-risk patients. Importantly, the use of non-invasive, pre-procedural information may also help promote more equitable access to risk stratification, particularly in settings where colonoscopy resources are limited or unevenly distributed. We aimed to develop and externally validate machine learning models to predict high-risk colorectal polyps using only non-invasive, pre-colonoscopy demographic, clinical, and behavioral features in a diverse, predominantly African American, urban cohort. We conducted a retrospective cohort study using demographic, lifestyle, and comorbidity data from patients who underwent colonoscopy at Howard University Hospital to develop and validate several machine learning models, including neural networks, random forest, support vector machines (SVM), Naive Bayes, logistic regression, decision trees, k-nearest neighbors (KNN), and XGBoost, for predicting high-risk colorectal polyps. High-risk polyps (HRP) were defined as villous or tubullovillous adenomas, high-grade dysplasia, polyps >= 10 mm in size, and/or the presence of >= 3 polyps per procedure; all other cases were classified as low-risk polyps (LRP). The dataset included 4,681 patients from 2015-2022 used for internal validation and 1,562 patients from 2023-2024 used for external validation.

3D reconstruction could improve colonoscopy by estimating mucosal coverage and alerting clinicians to missed regions during screening. However, algorithm development is limited as no current datasets provide both a realistic in vivo appearance and dense, time-resolved 3D ground truth, especially under non-rigid deformation. We present C3VD-DEFCOL, a framework and dataset for evaluating deformable colonoscopy reconstruction with paired geometry and realistic texture. Starting from C3VD/C3VDv2 colon meshes and camera trajectories, we generate controlled deformations of the colon surface, including peristaltic waves and centerline motion, and render per-frame depth, surface normals, optical flow, camera poses, and time-stamped 3D meshes. We then use the rendered geometry, primarily depth, to condition an LTX-2.3-based sim-to-real translation model that produces RGB clips with in vivo-like mucosal color, texture, vasculature, and specular appearance while preserving the underlying 3D scene structure. The resulting dataset contains 110 videos from 11 unique colon mesh geometries, with varying camera trajectories, appearances, and parameterized deformation regimes, including three peristaltic severity levels that serve as controlled evaluation axes. We evaluate the generated videos using appearance realism, geometric consistency, and temporal consistency metrics, and use the paired ground truth to benchmark the downstream task of pose estimation in deformable 3D reconstruction. Our experiments show how pose estimation error increases with increasing deformation severity, providing a controlled stress test that is not possible with existing in vivo datasets. Overall, C3VD-DEFCOL is designed as a reproducible, quantitative evaluation platform for testing deformable 3D reconstruction algorithms, with the goal of reducing the domain gap between synthetic datasets and in vivo colonoscopy.

Colo-segment recognition in colonoscopy videos is a key requirement for many downstream tasks, but existing automatic recognition methods only use colonoscopy images without fully exploiting the use of temporal information, leading to poor performance. Additionally, relevant public video-based datasets are in scarcity. To tackle this problem, we curate and release a labeled dataset specifically for the task of colo-segment recognition. In addition, we propose a two-stage deep learning-based framework, Colo-Segment Recognition via SpatioTemporal Network (ST-ColoNet), for the task of colo-segment recognition from colonoscopy videos which includes the Colorlaus module that uses metric learning to optimize edge-mediated spatial feature extraction, as well as the Full-Temp module which combines three self-attention patterns to better approximate full self-attention on long colonoscopy sequences and optimize temporal feature aggregation. Through extensive ablation experiments, we show that our framework is capable of achieving state-of-the-art performance on the task of colo-segment recognition, achieving an accuracy of 81.0% and F1-score of 70.7%, which is a tremendous improvement over state-of-the-art methods.

Accurate polyp size stratification guides surveillance decisions, with lesions larger than 5 mm typically requiring closer follow-up. However, monocular colonoscopy lacks a reliable metric reference. We present a diagnostic audit of binary polyp size classification (<=5 mm vs. >5 mm) across multiple public multi-center datasets, model families, and patient-stratified cross-validation. Across architectures and input modalities, including RGB appearance, relative depth, and photometry, model performance is moderately consistent, suggesting reliance on cues correlated with examination behavior rather than true metric scales. By providing ground-truth scale at varying granularities, we quantify the potential improvement from perfect scale information and show that current depth estimation and global calibration offer limited gains. We further demonstrate that segmentation errors under distribution shift eliminate most of this potential, with oracle scale under predicted masks recovering only baseline performance. These results highlight metric scale and mask robustness as two independent bottlenecks and provide reusable evaluation tools such as oracle scale ladders, shortcut partitions, and mask substitution for auditing future polyp sizing pipelines. Our code is publicly accessible at https://github.com/anaxqx/polyp-sizing-audit.

Surgical Video Question Answering (VideoQA) provides a promising paradigm for dynamic intraoperative interpretation, enabling real-time decision support and context-aware retrieval in clinical environments. Nevertheless, existing approaches are predominantly restricted to images or short clips, limiting their ability to model long-range procedural dynamics and causal dependencies across extended surgical workflows. To address this challenge, we propose SurgLQA, a unified long-horizon VideoQA framework for scalable surgical reasoning. This framework incorporates Faithful Temporal Consolidation (FTC), which leverages intrinsic temporal cues to construct compact long-range representations while preserving fine-grained temporal fidelity. Further, we develop Temporally-Grounded Multi-Policy Scaling (TMS), an adaptive test-time inference paradigm that strategically adjusts policy-level reasoning capacity within temporally grounded contexts. To facilitate systematic evaluation, we restructured a long-duration colonoscopy VideoQA benchmark, Colon-LQA, and conducted extensive experiments on Colon-LQA and REAL-Colon-VQA. Experimental results demonstrate that our approach achieves consistent performance gains in long-range reasoning with temporally grounded inference. Code link: https://github.com/RascalGdd/SurgLQA.

Accurate polyp segmentation in colonoscopy is essential for early colorectal cancer detection, yet real-world clinical environments pose persistent challenges such as motion blur, specular reflections, and illumination instability. Most existing methods are optimized on clean benchmark images and suffer noticeable performance degradation when deployed in authentic surgical scenarios. We propose DepthPolyp, a lightweight and robust segmentation framework based on pseudo-depth-guided multi-task learning and efficient feature modulation. The architecture combines hierarchical Ghost factorization for compact feature generation, Interleaved Shuffle Fusion for low-cost cross-scale interaction, and Dynamic Group Gating for adaptive group-wise feature weighting. Extensive experiments demonstrate that DepthPolyp achieves strong cross-dataset generalization when trained on degraded data and evaluated on both clean and noisy target domains, consistently outperforming lightweight baselines and remaining competitive with substantially larger models. In real surgical video evaluation on PolypGen, DepthPolyp achieves better segmentation performance than models up to $20\times$ larger while preserving real-time inference speed. With only 3.57M parameters and 0.86 GMACs, the proposed method runs at over 180 FPS on mobile devices, making it well suited for real-time deployment in resource-constrained clinical environments. Code and pretrained weights are available at: https://github.com/ReaganWu/DepthPolyp/

Geometric estimation including depth estimation and scene reconstruction is a crucial technique for colonoscopy which can provide surgeons with 3D spatial perception and navigation. However, geometric ground truth in colonoscopy is difficult to obtain due to narrow and enclosed space of the colon, while there is a large feature gap between simulated data and realistic data caused by artifacts and illumination. In this paper, we present CoGE, a novel framework for online monocular geometric estimation during colonoscopy. Firstly, we propose an illumination-aware supervision module based on the Retinex theory to address illumination diversity in different colonoscopy scenes. Moreover, a structure-aware perception module is proposed based on wavelet decomposition to extract common structural and local features of the colon. Both quantitative and qualitative results demonstrate that the proposed model solely trained on simulated data achieves state-of-the-art performance in geometric estimation for both simulated and realistic scenes.

Learning robust representations of polyp tracklets is key to enabling multiple AI-assisted colonoscopy applications, from polyp characterization to automated reporting and retrieval. Supervised contrastive learning is an effective approach for learning such representations, but it typically relies on correct positive and negative definitions. Collecting these labels requires linking tracklets that depict the same underlying polyp entity throughout the video, which is costly and demands specialized clinical expertise. In this work, we leverage the sequential workflow of colonoscopy procedures to derive self-supervised associations from temporal structure. Since temporally derived associations are not guaranteed to be correct, we introduce a noise-aware contrastive loss to account for noisy associations. We demonstrate the effectiveness of the learned representations across multiple downstream tasks, including polyp retrieval and re-identification, size estimation, and histology classification. Our method outperforms prior self-supervised and supervised baselines, and matches or exceeds recent foundation models across all tasks, using a lightweight encoder trained on only 27 videos. Code is available at https://github.com/lparolari/ntssl.

Controllable medical video generation has achieved remarkable progress, but it still lacks interpretability, which requires the alignment of generated contents with physical priors and faithful clinical manifestations. To push the boundaries from mere controllability to interpretability, we propose DepthPilot, the first interpretable framework for colonoscopy video generation. This work takes a step toward trustworthy generation through two synergistic paradigms. To achieve explicit geometric grounding, DepthPilot devises a prior distribution alignment strategy, injecting depth constraints into the diffusion backbone via parameter-efficient fine-tuning to ensure anatomical fidelity. To enhance intrinsic nonlinear modeling under these geometric constraints, DepthPilot employs an adaptive spline denoising module, replacing fixed linear weights with learnable spline functions to capture complex spatio-temporal dynamics. Extensive evaluations across three public datasets and in-house clinical data confirm DepthPilot's robust ability to produce physically consistent videos. It achieves FID scores below 15 across all benchmarks and ranks first in clinician assessments, bridging the gap between "visually realistic" and "clinically interpretable". Moreover, DepthPilot-generated videos are expected to enable reliable 3D reconstruction, facilitating surgical navigation and blind region identification, and serve as a foundation toward the colorectal world model.

Early identification and removal of polyps can reduce the risk of developing colorectal cancer. However, the diverse morphologies, complex backgrounds and often concealed nature of polyps make polyp segmentation in colonoscopy images highly challenging. Despite the promising performance of existing deep learning-based polyp segmentation methods, their perceptual capabilities remain biased toward local regions, mainly because of the strong spatial correlations between neighboring pixels in the spatial domain. This limitation makes it difficult to capture the complete polyp structures, ultimately leading to sub-optimal segmentation results. In this paper, we propose a novel adaptive spectrum guidance network, called ASGNet, which addresses the limitations of spatial perception by integrating spectral features with global attributes. Specifically, we first design a spectrum-guided non-local perception module that jointly aggregates local and global information, therefore enhancing the discriminability of polyp structures, and refining their boundaries. Moreover, we introduce a multi-source semantic extractor that integrates rich high-level semantic information to assist in the preliminary localization of polyps. Furthermore, we construct a dense cross-layer interaction decoder that effectively integrates diverse information from different layers and strengthens it to generate high-quality representations for accurate polyp segmentation. Extensive quantitative and qualitative results demonstrate the superiority of our ASGNet approach over 21 state-of-the-art methods across five widely-used polyp segmentation benchmarks. The code will be publicly available at: https://github.com/CSYSI/ASGNet.

Early screening via colonoscopy is critical for colon cancer prevention, yet developing robust AI systems for this domain is hindered by the lack of densely annotated, long-sequence video datasets. Existing datasets predominantly focus on single-class polyp detection and lack the rich spatial, temporal, and linguistic annotations required to evaluate modern Multimodal Large Language Models (MLLMs). To address this critical gap, we introduce Colon-Bench, generated via a novel multi-stage agentic workflow. Our pipeline seamlessly integrates temporal proposals, bounding-box tracking, AI-driven visual confirmation, and human-in-the-loop review to scalably annotate full-procedure videos. The resulting verified benchmark is unprecedented in scope, encompassing 528 videos, 14 distinct lesion categories (including polyps, ulcers, and bleeding), over 300,000 bounding boxes, 213,000 segmentation masks, and 133,000 words of clinical descriptions. We utilize Colon-Bench to rigorously evaluate state-of-the-art MLLMs across lesion classification, Open-Vocabulary Video Object Segmentation (OV-VOS), and video Visual Question Answering (VQA). The MLLM results demonstrate surprisingly high localization performance in medical domains compared to SAM-3. Finally, we analyze common VQA errors from MLLMs to introduce a novel "colon-skill" prompting strategy, improving zero-shot MLLM performance by up to 9.7% across most MLLMs. The dataset and the code are available at https://abdullahamdi.com/colon-bench .

Improving the reliability and completeness of colonoscopic inspection is critical for reducing missed lesions and improving colorectal cancer prevention. Reliable scene understanding is essential for navigation, reconstruction, and assessment of inspection completeness. Anatomical structures such as mucosal folds provide stable geometric cues for endoscope localization, while surgical instruments introduce dynamic occlusions that complicate visual interpretation. However, existing gastrointestinal endoscopy datasets largely focus on disease detection or artifact segmentation, leaving a gap in precise annotations of structural landmarks and instruments. We introduce SegCol, a dataset and benchmark for semantic segmentation of colon fold edges and surgical instruments derived from the EndoMapper dataset. SegCol provides manually annotated pixel-level masks for three instrument classes and thin fold-edge structures across temporally consistent image sequences. It forms the basis of the SegCol Challenge, organized as part of the EndoVis Challenge at MICCAI 2024, evaluating both supervised segmentation and annotation-efficient active learning. We further study segmentation metrics, including Dice, ODS/OIS, AP, and CLDice, under structural perturbations and different object geometries, and analyze participating methods, architectural choices, and active learning strategies. Our findings show that metric behavior strongly depends on target structure, highlighting the need for carefully selected evaluation protocols in endoscopic segmentation. Details are available at https://www.synapse.org/Synapse:syn54124209/wiki/626563, and code at https://github.com/surgical-vision/segcol_challenge.