Video Capsule Endoscopy

Automated assessment of the Critical View of Safety (CVS) in laparoscopic cholecystectomy requires both recognition of the three CVS criteria and anatomical grounding in small, rare, and often occluded hepatocystic structures. Learning-based methods differ in the anatomical information they use, from image-level classification to detection, segmentation, or graph-based reasoning, yet grounding the safety-critical anatomy remains the main bottleneck. We propose CasCVS-Net, a staged multi-task cascade that jointly performs object detection, semantic segmentation, and CVS assessment, trained on the Endoscapes dataset. The model couples the tasks through predicted anatomy: predicted boxes guide segmentation, and predicted masks provide region-level features for CVS classification, so CVS assessment at inference uses only model predictions rather than ground-truth annotations. To reduce optimisation instability in this coupled setting, training progresses from detection to detection-segmentation and then to the full three-task cascade, followed by task-wise fine-tuning. Evaluation on the public unseen test set shows that CasCVS-Net improves over matched single-task baselines on all three tasks, achieving 32.0 detection mAP, 46.8 semantic mIoU, 15.3 rare-anatomy mIoU, and 67.2 CVS mAP. It outperforms the state-of-the-art LG-CVS and SV2LSTG by 6.3% and 4.5% relative CVS mAP, respectively, corresponding to 4.0 and 2.9 mAP points. These results show that staged task coupling through predicted boxes and masks improves anatomical grounding for CVS assessment, particularly for rare hepatocystic structures.

Hereditary polyposis syndromes can be precursor lesions to colorectal cancer and are associated with a broad spectrum of extracolonic tumors. Early identification and accurate classification of these syndromes are essential for timely diagnosis, individualized patient management, and targeted surveillance strategies for affected families. However, public endoscopic datasets are largely organized around the individual sporadic polyp, and none links the polyposis phenotype to histopathology and germline findings at the patient level. Here, we present ERCPMP-Gx, an endoscopic, histopathological, and genomic dataset developed to support the application of artificial intelligence (AI) in the recognition, characterization, and classification of colorectal polyposis. Most procedures were performed using the Olympus EVIS X1 system with white-light endoscopy (WLE), narrow-band imaging (NBI), magnifying NBI (M-NBI), and NBI with near focus modes, yielding 160 images and accompanying video clips. Approximately eighty percent of cases represent clinically and/or genetically confirmed hereditary polyposis syndromes (PG), including familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), juvenile polyposis syndrome (JPS), and ganglioneuroma syndrome (GNS), while the remaining twenty percent comprise non-hereditary polyps and polyp-mimicking lesions with overlapping morphological features (Non-PG), included to support differential classification. Each released record is linked, where available, to standardized endoscopic annotations, representative histopathology, and clinically reported germline findings, forming an AI-ready, patient-level annotation framework. The dataset is publicly accessible at Mendeley (https://doi.org/10.17632/nzyfc544bx.2). For the latest updates and further information, readers are referred to the DataBioX website: https://databiox.com.

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.

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.

Surgical instrument segmentation is a fundamental task for computer-assisted interventions, yet most existing methods rely on pixel-level annotations or manual spatial prompts, which limit scalability and automation. The recently introduced Segment Anything Model 3 (SAM3) offers a pathway to annotation-free, automatic segmentation via text-based prompting; however, the instrument name as a text prompt could not be directly used due to a large domain gap. To overcome these limitations, we propose a two-stage framework that achieves instance-level segmentation without requiring ground truth masks or manual interaction. In the first stage, we leverage a natural-language-aligned generic prompt - "tool" - to produce binary masks using SAM3's zero-shot capability. In the second stage, these masks are extended to instance-level by integrating a vision-language model (Qwen) that is fine-tuned on SAM3-generated masked regions for instrument classification. We evaluate our approach on the EndoVis 2017 and 2018 datasets. Results show that, while our two-stage approach does not reach the performance of current fully supervised methods, it significantly outperforms the direct use of SAM3 for instance-level instrument segmentation with text prompts. Overall, our findings highlight both the limitations and potential of SAM3, suggesting a promising direction toward annotation-free surgical instrument segmentation.

Fiber-bundle endoscopy offers a compact and flexible route for clinical fluorescence imaging through natural human orifices, but since its first report in the 1950s, it has remained limited by low spatial resolution, honeycomb artifacts, and inter-core crosstalk. The crosstalk becomes more pronounced at near-infrared-II wavelengths (NIR-II, 1000-3000 nm), a spectral window that offers superior contrast, resolution, and tissue penetration depth for biomedical imaging. Here, we present an AI-powered flexible endoscopy platform that overcomes these constraints through optical-computational co-design: optimizing ultrathin fiber bundles to mitigate crosstalk-induced image blur and enable high-fidelity image transmission across the visible-to-NIR-II spectral range, and developing an Agent-Guided Mixture-of-Experts (GAME) pipeline for honeycomb-artifact removal and image restoration. GAME provides a single restoration entry point for diverse biomedical images acquired with our endoscope, spanning cell, mouse and human samples. It dynamically routes each input to suitable restoration experts via a vision-language model, facilitating image reconstruction with a fourfold resolution improvement beyond the NyquistShannon sampling limit. The utility of our endoscope is demonstrated through in vivo NIR-II imaging of anatomical structures in mice, as well as imaging of the digital micromirror device (DMD)-projected human gastric tube and lymphatic system, paving the way for future clinical translation.

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 development of foundation models (FMs) is crucial for advancing endoscopic image analysis. However, existing endoscopy FMs mainly rely on self-supervised learning from uni-modal images or videos, overlooking the rich semantic knowledge contained in clinical reports. Furthermore, effectively leveraging these records is hindered by a fundamental modality gap: structured anatomical descriptions are not naturally mapped to specific frames within the high-redundancy, uncurated visual streams. In this paper, we present EndoVLM, a novel vision-language FM pre-trained on over 348K endoscopic examinations, each pairing a clinical report with its corresponding image collection. An Anatomy-Guided Sparse Pooling mechanism utilizes textual descriptions as queries to drive sparse attention, efficiently aggregating semantically salient frames into anatomy-specific visual representations across redundant image-sets. Next, a Progressive Semantic-Aware Alignment strategy models clinical taxonomy (anatomy and pathological status) via structured soft targets, bridging the gap from global patient-level matching to fine-grained localized alignment. Finally, a Semantic-Concentrated Masked Autoencoder is applied exclusively to these semantic-rich frames, integrating low-level visual precision with robust high-level semantic representation. Extensive experiments across various downstream tasks demonstrate that EndoVLM outperforms existing foundation models and remains competitive with task-specific methods. Remarkably, EndoVLM also exhibits robust zero-shot generalization capabilities, highlighting its potential for broader clinical application.

Depth estimation is a significant task for 3D perception in endoscopic surgeries. However, illumination interference and feature diversity in various endoscopic scenes are still challenges for generalizable depth estimation and ego-motion estimation. Based on this, a novel self-supervised framework, EndoMINI, is proposed for depth estimation in endoscopic scenes. Specifically, mixture of low-rank experts (MiLoRE) is proposed to perform parameter-efficient fine-tuning, which can also boost the model adaptation to scenes with different characteristics. Meanwhile, an intrinsic image alignment (IIA) is introduced into the training loss to alleviate the influence of light reflectance in endoscopy with a novel intrinsic image decomposition network. The proposed method is evaluated on SCARED datasets for supervised depth estimation, and two endoscopic datasets, Hamlyn and SERV-CT, for zero-shot depth estimation, compared with state-of-the-art works as well. The experimental results demonstrate outstanding performance of the proposed model and the effects of the main contributions.

Gastrointestinal (GI) endoscopic image analysis has shifted from single-label classification toward visual question answering (VQA), where a model must answer free-form clinical questions about an image. While recent vision-language models (VLMs) achieve promising answer accuracy on this task, clinical adoption also requires the model's internal representations to reflect the visual evidence behind its answers. We propose a simple multi-task fine-tuning recipe that constructs auxiliary grounding and description tasks from an existing VQA dataset with minimal additional annotation: expert-annotated polyp masks are reused directly, while a GI-domain pretrained classifier with Grad-CAM localization provides weak supervision for finding categories that lack ground-truth masks. Three small VLM backbones are fine-tuned with low-rank adaptation under matched VQA-only and multi-task recipes on Kvasir-VQA-x1, and we show consistent accuracy gains together with improved implicit alignment between answer tokens and the relevant image region, evaluated on both in-distribution and out-of-distribution data.

Quantitative drug-induced sleep endoscopy (DISE) requires reliable airway boundaries at specific anatomical levels. Pixel-level DISE annotations are scarce, and manual contouring limits the scalability of quantitative assessment. To address this limitation, we developed ASTRA-Net for known-plane DISE segmentation with limited real annotations. Stage 1 aligned intermediate ConvNeXt-Base representations from 14,250 unlabeled virtual endoscopy frames derived from computed tomography and real DISE frames. Virtual images were used only for feature alignment. Stage 2 fine-tuned four independent UNet++ decoders on 401 real annotated frames. Structured zero-mask supervision constrained incompatible plane outputs and invalid frames. Six alignment configurations used maximum mean discrepancy, domain adversarial learning, or both objectives. On a hold-out evaluation set of 100 frames, the five-model MMD-only segmentation ensemble achieved a mean Dice of 0.8927, with a 95% image-level bootstrap interval of 0.8631 to 0.9160. The mean intersection over union was 0.8239. A classification- enabled variant of the same alignment configuration reached a restricted four-plane top-1 accuracy of 0.92 on the same hold-out frames. These results indicate that ASTRA-Net can support frame-level, plane-specific DISE boundary delineation when real annotations are limited.

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.

Safe navigation within the spinal subarachnoid space is constrained by its narrow, compliant, and delicate anatomy. Conventional catheters and continuum robots rely on proximal pushing, generating friction and shear along the tissue device interface that limit distal controllability and increase the risk of neural injury. Here, we present a 2 mm diameter eversion-growing robotic platform that enables friction minimised extension and steering within the human spinal subarachnoid space, validated through computational modelling, phantom experiments, and intact human cadaver studies. The robot integrates a miniature endoscope for real time intrathecal visualisation and advances by pressure driven tip eversion, localising motion to the distal tip while minimising translational sliding of the deployed body. Phantom experiments demonstrated reductions of 65.2% in mean interaction force and 48.0% in peak interaction force compared with matched push-based insertion. Physics based modelling showed that eversion based growth redistributed tissue loading, reducing local stress concentrations and interfacial shear relative to conventional insertion. In an intact human cadaver, the system achieved 150 mm of controlled intrathecal extension with concurrent fluoroscopic and endoscopic visualisation, providing access across multiple vertebral levels from a standard lumbar entry point. Postprocedural laminectomy and durotomy revealed no observable macroscopic disruption of the dura mater or surrounding neural structures. These results provide the first mechanically characterised and multimodally validated demonstration of eversion-based robotic navigation in intact human spinal anatomy, establishing a quantitative and procedural foundation for future intrathecal interventions. Further validation in larger anatomical cohorts and under physiological conditions will be required before clinical translation.

Endoscopic visual question answering (VQA) increasingly asks complex questions that combine several endoscopic answer components rather than isolated factual queries. Such complex answers may be scored as correct even when the same model fails on associated atomic questions. We introduce EndoCA, a paired complex-atomic answer consistency benchmark for evaluating whether complex answers remain consistent with same-image atomic answers. EndoCA contains two suites: EndoCA-Core evaluates compact question-complexity patterns commonly seen in practical endoscopic VQA, and EndoCA-Diagnostic supports controlled analysis across increasing question complexity. We evaluate 11 VLMs spanning open, medical, endoscopy-adapted, and closed-source models on EndoCA. Some VLMs achieve high complex-answer accuracy, yet their atomic-answer accuracy and complex-atomic answer consistency remain substantially lower. To reduce this complex-atomic inconsistency, we introduce Atomic-Support Reconciliation (ASR), a training-free mechanism that uses model-generated atomic answers as contextual premises for answer revision and consistency-guided selective answering. On four selected publicly available models, ASR-Revise improves paired complex-atomic correctness with modest changes in complex-answer accuracy, while ASR-Selective improves accuracy on answered cases by allowing the model to abstain from less reliable cases. Together, EndoCA and ASR provide a consistency-aware benchmark and a training-free mechanism for answer reconciliation and selective answering in endoscopic VQA.

Early and timely screening of laryngeal cancer is crucial for improving clinical outcomes. In recent years, NBI endoscopy has become a standard diagnostic tool for the detection of laryngeal lesions. However, its effective use requires well-trained clinicians and the procedure is time-consuming and subject to interobserver variability. In this context, the application of artificial intelligence (AI) offers a promising solution to support clinical decision-making. In this work, we proposed applying transformer and attention mechanism for analyzing the narrow band imaging and distinguish benign and malignant lesions. Results show it has good classification performance with F1 (82.72%), accuracy(82.33%). In addition, the result of laryngeal cancer screening is explainable for clinicians. The explainability is utilizing the state of art segmentation method (MedSAM) to provide the useful pathological information area for clinicians. The proposed methodology fusing classification and segmentation provides a translating on laryngeal cancer screening.

Surgical video understanding is fundamental to navigation systems. Endoscopic perception is often hindered by a limited field-of-view and frequent instrument occlusions, making spatio-temporal context essential for robust inference. These challenges have motivated video models that aggregate information across frames. However, existing video models typically store past observations implicitly in learned feature representations, often requiring task-specific video training, substantial annotated data, and increased computational cost. We propose Stitch-Inferencer, a real-time, model-agnostic inference framework that replaces implicit feature memory with an explicit image-space panoramic canvas. By stitching valid observations across frames, Stitch-Inferencer preserves previously observed pixels in an online, instrument-free view, expanding the effective field-of-view and providing direct access to regions that are temporarily occluded or absent from the current frame. Downstream segmentation or tracking models are applied to a compact region of interest on the panorama, and their predictions are reprojected to the current frame, enabling existing models to exploit long-range context without retraining. Experiments on anatomy segmentation and point/box tracking demonstrate consistent improvements across diverse baselines while preserving real-time throughput. The stitching module alone runs at over 60 FPS, providing a practical inference-time solution to enhance endoscopic perception in computationally constrained intraoperative environments. Source code will be made publicly available.

Robot-assisted minimally invasive surgery (MIS) critically depends on reliable endoscopic perception for navigation and safety. However, conventional endoscopes provide only a limited field of view, leaving large portions of the surrounding anatomy unobserved. Recent neural rendering approaches, such as Neural Radiance Fields and 3D Gaussian Splatting, enable novel view synthesis from endoscopic videos, but their reliance on sparse observations often leads to severe artifacts when extrapolating beyond the training trajectory. In this work, we propose ExtraGS, a framework for enhancing endoscopic view extrapolation through diffusion-guided 3D Gaussian Splatting. Starting from an initial reconstruction, we introduce an uncertainty-guided virtual camera sampling strategy to actively explore blind spots and maximize information gain. The rendered views from these sampled locations are refined using a diffusion model to recover plausible anatomical structures, producing pseudo-observations that guide further optimization. To prevent the generated content from degrading reliable regions, we adopt a confidence-weighted fine-tuning strategy when incorporating these pseudo-observations. Extensive experiments on multiple public endoscopic datasets demonstrate that ExtraGS significantly reduces extrapolation artifacts and achieves state-of-the-art performance in endoscopic novel view synthesis.

Chromoendoscopy (CE) is a common clinical practice that sprays indigo carmine blue dye onto the gastric surface to improve the visibility of gastric lesions, such as an early cancer. While CE is effective in detecting the lesions, preparing and spraying the dye needs additional cost and time, which is undesirable both for patients and medical practitioners. To overcome this issue, virtual chromoendoscopy (V-CE) was recently proposed, which applies a learned image translation model to virtually generate a CE image from a standard endoscopy (SE) image. In this paper, we propose virtual enhanced chromoendoscopy (V-ECE) that combines V-CE with image enhancement techniques to further improve the visibility of gastric lesions. Because a desired enhancement level depends on the inspected lesion and the practitioner's preference, we introduce a novel image translation model that can generate V-ECE images using an enhancement level tunable by a user. Experimental results demonstrate that our proposed model can plausibly generate V-ECE images with various enhancement levels using a unified model.

Referring Image Segmentation (RIS) aims to segment image regions specified by natural language, enabling fine-grained and controllable visual understanding. Extending RIS to endoscopic imagery, however, presents unique challenges, including scarce high-quality annotations and complex, domain-specific image-text relationships. Although recent vision-language models demonstrate strong cross-domain alignment, they often fail to capture fine-grained textual cues in endoscopic settings, resulting in suboptimal performance and limited generalization. To address these challenges, we introduce ReferEndoscopy, a large-scale benchmark for RIS in the endoscopy field. Building on this dataset, we propose the Attribute Retrieval-based Endoscopic-RIS (AR-ERIS) framework for open-vocabulary endoscopic compositional referring segmentation. AR-ERIS leverages attribute retrieval for open-vocabulary endoscopic compositional referring segmentation and is pretrained on the curated ReferEndoscopy dataset, achieving state-of-the-art performance with strong generalization across both simulated and real-world endoscopic data. The dataset and code will be publicly released upon completion of the review process.

In this document, we describe characteristics and technical details of the multimodal biosignal dataset DOSE-I of procedural sedation for endoscopy published on zenodo. The DOSE-I dataset includes 78.5 hours of recording in 171 records ranging from 6.7 to 70.8 minutes (mean: 27.5, SD: 11.6) of 281 endoscopic procedures. 1129 (median: 6 per record) transitions of consciousness and 7328 (median: 39 per record) individual sedation depth labels were recorded. In addition to clinically annotated biosignals, the DOSE-I dataset provides detailed static data about the respective study subject and metadata about the respective recordings. To further support future research, we provide details about artifact detection and preprocessed pEEG features, too. C code used for this preprocessing is provided separately via Github.

Novel view synthesis (NVS) is an active research topic in computer vision, owing to the success of neural radiance field (NeRF) and 3D Gaussian splatting (3DGS) methods. While NVS opens the door to potential applications in gastroendoscopy, such as extending the field of view of endoscopic images and enabling digital twins for 3D archiving and endoscopist manipulation training, the dataset is insufficient to evaluate NVS for gastroendoscopy. In this paper, we present the first real gastroscopy dataset for NVS, namely the GastroNVS dataset, which contains a set of gastroscopic images, camera poses, and a point cloud for real gastroendoscopy inspection. To assess the suitability of the GastroNVS dataset, we evaluate several 3DGS methods and discuss the challenges for future development. The dataset is available on request from our project page.

Vision-language models (VLMs) are prone to hallucination, which remains a major barrier to their safe deployment in clinical practice. To date, most hallucination detection methods have been evaluated on radiology benchmarks such as MIMIC-CXR and VQA-RAD, while gastrointestinal (GI) endoscopy remains largely underexplored. In this paper, we benchmark nine hallucination detection methods on the Gut-VLM dataset, a GI diagnostic Visual Question Answering (VQA) dataset with 4,392 test VQA pairs, across five VLMs (MedGemma-4B, MedGemma-27B, LLaVA-Med-7B, LLaVA-v1.6-7B, and Lingshu-32B). The methods span three categories: black-box methods (RadFlag, SelfCheckGPT-NLI), gray-box methods (AvgProb, AvgEnt, MaxProb, MaxEnt, Semantic Entropy, and VASE), and a white-box method (ReXTrust). Our results show that ReXTrust, a white-box method, achieves the highest AUC across all five models, outperforming the strongest alternative method on each VLM by a statistically significant margin (paired permutation test, p < 0.001 in all cases), reaching a peak AUC of 93.0 on MedGemma-4B. White-box hidden-state access provides a consistent advantage of 19.5 AUC points on average (range: 9.5--33.5), with ReXTrust maintaining strong performance even on LLaVA-v1.6-7B (AUC 79.9), where black-box methods and clustering-based gray-box methods collapse to near-chance performance. Among non-white-box methods, token-level gray-box statistics (MaxEnt, MaxProb) are the strongest alternatives, outperforming both clustering-based gray-box methods (Semantic Entropy, VASE) and black-box approaches on average. We further identify confident confabulation, a failure mode in which models hallucinate with high inter-sample consistency or high token-level probability, as a systemic failure for both consistency and uncertainty-based methods.

Gastrointestinal cancers represent a growing health burden in the South Asian region, driven largely by rapid changes in socio-economic conditions & lifestyle habits. However, early diagnosis of such malignancies remains a significant challenge, largely due to a lack of modern equipment, lack of financial support, and a scarcity of GI experts. AI-assisted diagnosis & report generation, show great promise in alleviating this problem by providing low-skill manpower the technical expertise to perform diagnosis. However, almost all open-source, publicly available datasets are predominantly collected from the European region, with no representation from the South Asian region. The lack of open-source GI datasets from diverse geographic regions has made it difficult to assess whether population bias is present in existing models, and to develop geographically inclusive AI tools for automated GI diagnosis. To address this gap, we introduce SAGE: An Expert-Annotated South Asian GI Endoscopy dataset for image captioning, multi-label classification, and visual question answering (VQA) tasks. It consists of 1,300 images, their captions along with hallucination tag, 18 labels and 14,726 question-answer pairs making it well-suited for diverse range of tasks including classification, benchmarking, and fine-tuning large multimodal models (LMMs). We further conducted benchmarking of multi-class classifiers on the effect of population shift in GI imaging AI tasks, and contemporary LMMs on their performance. Our study reveals that task-specific models, such as multi-class classification models, suffer the most, with an average performance drop of 58% when evaluated on the South Asian dataset. For contemporary LMMs, benchmarking reveals a substantial drop in the average GREEN score for anatomical landmark detection (0.308) and abnormality detection (0.410).

Gastric intestinal metaplasia (GIM) is a precursor lesion to gastric dysplasia and adenocarcinoma whose early detection is crucial for intervening in the carcinogenesis cascade. Artificial intelligence (AI) holds considerable promise for real-time endoscopic detection and characterization of GIM. However, development of reliable AI models has been constrained by the absence of publicly available, histopathologically validated datasets that combine detailed endoscopic annotations, histological subtype (complete and incomplete), standardized grading systems, and normal mucosal patterns. GIM-ENDO was designed to fill this gap. The dataset comprises demographic data, endoscopic findings, histopathological results, and H. pylori status acquired using the Olympus EVIS X1 system with white-light endoscopy (WLE) and image-enhanced endoscopy (IEE), including narrow-band imaging (NBI) and magnifying NBI (M-NBI), along with images and video clips from 24 patients (22 GIM-positive, 2 normal controls). Annotations cover six primary IEE endoscopic signs -- light blue crest (LBC), marginal turbid band (MTB), white opaque substance (WOS), TV pattern (Fusion), atrophy, and map-like erythema (MLE) -- plus two additional endoscopic findings (AHP and GA) recorded where present. GIM subtypes (complete and incomplete) are annotated for all GIM-positive cases; OLGA and OLGIM staging are provided where complete histological sampling was available. The dataset is publicly accessible at https://doi.org/10.5281/zenodo.20707267. For the latest updates and further information regarding this dataset, readers are referred to the DataBioX website: https://databiox.com A short version of this work has been submitted to MICCAI 2026 Open Data Track.

Endoscopic video analysis is essential for gastrointestinal diagnosis and computer-assisted interventions, but video sequences are routinely degraded by specular reflections, motion artifacts, and missing frames. These transient corruptions can distract clinicians, reduce image interpretability, and disrupt downstream tasks such as 3D reconstruction and navigation. Effective restoration therefore requires methods that exploit temporal continuity rather than treating frames in isolation. We introduce a Gaussian Process Prior Variational Autoencoder (GPVAE) framework for endoscopic video restoration that replaces the standard factorized latent prior with a temporal Gaussian process prior, enabling interpolation of missing frames with uncertainty-aware reconstruction. The framework combines endoscopy-specific encoders, including a convolutional EndoVAE backbone and pretrained Vision Transformer encoders from GastroNet-5M, with two scalable GP approximations: Hierarchical Prior Approximation (HPA) and Sparse Precision Approximation (SPA). Specular reflections are handled using a DUCKNet-based masking pipeline that excludes corrupted pixels from the reconstruction objective. On the C3VDv2 colonoscopy dataset, the best GPVAE variants reduced image reconstruction RMSE by 21.9% on average, and by up to 26.1%, relative to matched VAE baselines. Downstream trajectory RMSE was reduced by 12.7% on average across classical visual odometry and a pretrained PoseNet, at an average increase of 27.3% in training time per epoch. Finally, the GP posterior provides per-frame uncertainty estimates that reflect temporal support and offer a confidence signal for restored frames.

Accurate vision-based navigation in monocular endoscopy is difficult due to limited depth cues, weak tissue texture, non-rigid deformation, and substantial appearance variation across domains, all of which complicate pose estimation, depth prediction, and image-to-anatomy alignment. Although recent vision foundation models have shown promise, their learned representations often remain insufficiently geometry-consistent, hindering stable feature correspondence and limiting their reliability for downstream navigation tasks. We propose a unified framework for learning geometry-consistent and domain-robust image representations for monocular endoscopy. The framework combines a synthetic data pipeline that provides accurate geometric supervision with Hierarchy-Aware Geometry-Semantic Adaptation, a structured alternative to standard LoRA that inserts low-rank adapters selectively across the transformer hierarchy and couples them with layer-wise training objectives to encourage geometric correspondence in intermediate features and semantic consistency in deeper features. Experiments on public and proprietary datasets show improved geometric and semantic representation quality, leading to better performance on downstream navigation tasks including pose estimation and monocular depth estimation. The learned representations show favorable synthetic-to-real transfer on clinical bronchoscopy and provide a useful initialization for adaptation to sinus endoscopy and colonoscopy under limited supervision. The framework also shows favorable scaling with model size and training data. These results support hierarchy-aware, geometry-guided adaptation as a practical approach for endoscopic representation learning.

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.

Reasoning capability has significantly advanced complex logical inference and robotic decision-making in general domains. However, its potential in the Artificial Intelligence (AI) copilot robot-particularly implemented based on the Vision-Language-Action (VLA) model-remains unexplored in endoscopic surgery. Effective reasoning should enable AI copilot robots to integrate multimodal cues, interpret surgical intent, and infer hidden tissue dynamics, thereby alleviating intraoperative uncertainty and cognitive burden on surgeons. Properly implemented, reasoning-driven autonomy can transform AI copilot robots from reactive executors into cognitive collaborators, enhancing precision, safety, and sustainability in clinical practice.

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.

Capsule endoscopy event detection is challenging because clinically relevant findings are sparse, visually heterogeneous, and evaluated at the event level rather than by frame accuracy. We propose VISTA, a metric-aligned multi-backbone framework for the RAREVISION task. VISTA combines EndoFM-LV for temporal context and DINOv3 ViTL/16 for frame-level visual semantics, followed by a Diverse Head Ensemble (DHE), Validation-Guided Weighted Fusion (VGWF), and Anatomy-Aware Temporal Event Decoding (ATED). The original official submission achieved hidden-test temporal mAP@0.5 of 0.3530 and mAP@0.95 of 0.3235. After the competition, extending local threshold refinement with a global coarse search improved performance to 0.3726 mAP@0.5 and 0.3431 mAP@0.95, ranking Team ACVLab second in the post-competition evaluation.

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.

Clinical trial studies indicate benefit of watch-and-wait (WW) surveillance for patients with rectal cancer showing a complete or near clinical response (CR) directly after treatment (restaging). However, there are no objectively accurate methods to early detect local tumor regrowth (LR) in patients undergoing WW from follow-up exams. Hence, we developed Temporal Rectal Endoscopy Cross-attention (TREX), a longitudinal deep learning approach that combines pairs of images acquired at restaging and follow-up to distinguish CR from LR. TREX uses pretrained Swin Transformers in a siamese setting to extract features from longitudinal images and dual cross-attention to combine the features without spatial co-registration between image pairs. TREX and Swin-based baselines were trained under two settings: (a) detecting LR or CR at the last available follow-up and (b) early detection of LR at 3--6, 6--12, and 12--24 months before clinical confirmation. TREX achieved the highest accuracy in detecting LR with a high sensitivity of 97% $\pm$ 6% and a balanced accuracy of 90% $\pm$ 3%, and outperformed all baselines in early detection at both 3--6 (74% $\pm$ 1%) and 6--12 months (62% $\pm$ 4%) prior to clinical detection. Clinical validation via a surgeon survey showed that TREX matched attending-level overall accuracy (TREX: 86.21% vs.\ Clinicians: 87.84% $\pm$ 1.28%). Finally, we explored TREX's ability to predict treatment response by combining pre-treatment (pre-TNT) and restaging endoscopies, achieving a balanced accuracy of 73% $\pm$ 12%. These results show that longitudinal deep learning analysis of endoscopy may improve surveillance and enable earlier identification of rectal cancer regrowth.

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.

Wireless capsule endoscopy (WCE) enables painless visualization of the gastrointestinal tract, but its diagnostic potential is limited by incomplete mucosal coverage and poor transferability of existing navigation methods across patient anatomies. We propose a transferable, anatomical landmarkguided deep reinforcement learning (AL-DRL) framework for autonomous gastric navigation. Leveraging a lightweight edgecontour-depth fusion module, our policy operates on stable, lowdimensional landmark coordinates rather than high-dimensional video streams, effectively bridging the sim-to-real gap. In simulations across eight patient-derived models, the method achieves over 97% coverage within 50 seconds, significantly outperforming vanilla PPO, SAC, and DQN agents. A two-stage sim-to-real pipeline with an adaptive dynamic programming controller actively mitigates physical disturbances. Ex-vivo experiments demonstrate a mean coverage of 87% and a 53% reduction in procedure time compared with expert manual control.

Synthesizing longitudinal medical images at controllable disease stages while preserving patient-specific anatomy is hindered by the entanglement of pathological textures and structural features. We address this challenge for ulcerative colitis (UC) endoscopy, where severity follows a continuous ordinal progression along the Mayo Endoscopic Score (MES). Our framework, Disentangled Anatomy-Disease Diffusion (DADD), conditions a latent diffusion model on two complementary embeddings: a pretrained image encoder for patient anatomy and a separately trained ordinal embedder for cumulative disease severity. Since image embeddings inevitably capture disease information, we introduce a Feature Purifier, a cross-attention-based erasure mechanism that identifies and suppresses disease-correlated channels, yielding purified anatomical representations. These cleaned anatomy tokens and target disease tokens are injected into the denoising network via a Triple-Pathway Cross-Attention mechanism with resolution-dependent routing gates. This architecture leverages the U-Net hierarchy, in which different network depths encode global structure versus fine-grained pathological texture. Furthermore, we introduce Delta Steering, a training-free directional signal derived from the ordinal embeddings that enables explicit, single-pass control over disease transitions at inference without requiring additional forward passes. Validated on the LIMUC dataset, our approach produces high-fidelity images across all severity levels and effectively rebalances skewed class distributions, enhancing performance for downstream classification tasks. The dataset is available at zenodo.org/records/5827695 and the code base at github.com/umutdundar99/progressive-stable-diffusion

Video Capsule Endoscopy (VCE) is a promising method for improving the medical examination of the small intestine in the gastrointestinal tract. A key challenge is their limited size, resulting in a short battery lifetime which conflicts with high energy consumption for image capturing and transmission to an on-body device. Thus, we propose an image compression pipeline that substantially reduces the transmitted data while preserving diagnostic image quality. Furthermore, we exploit characteristics of the compression process to identify frames with low diagnostic value mainly caused by bubbles, without requiring additional image analysis. For low-visibility frames, a dynamic bubble-aware frame rate adaptation strategy reduces image acquisition and transmission during these phases while preserving sensitivity to potential anomalies. The proposed compression and frame rate adaptation are evaluated on a RISC-V platform using the Kvasir-Capsule and Galar datasets. The compression method achieves a compression ratio of 5.748 (82.6%) at a peak signal-to-noise ratio of 40.3 dB, indicating negligible loss of visual quality. The compression accomplished a mean energy reduction of the whole system by 20.58%. Additionally, the proposed bubble-aware frame rate adaptation reduced the energy consumption by up to 40%. These results demonstrate the potential of our method to increase the applicability of VCE.

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.

Super-resolution (SR) models are attracting growing interest for enhancing minimally invasive surgery and diagnostic videos under hardware constraints. However, valid concerns remain regarding the introduction of hallucinated structures and amplified noise, limiting their reliability in safety-critical settings. We propose a direct and practical framework to make SR systems more trustworthy by identifying where reconstructions are likely to fail. Our approach integrates a lightweight error-prediction network that operates on intermediate representations to estimate pixel-wise reconstruction error. The module is computationally efficient and low-latency, making it suitable for real-time deployment. We convert these predictions into operational failure decisions by constructing Conformal Failure Masks (CFM), which localize regions where the SR output should not be trusted. Built on conformal risk control principles, our method provides theoretical guarantees for controlling both the tolerated error limit and the miscoverage in detected failures. We evaluate our approach on image and video SR, demonstrating its effectiveness in detecting unreliable reconstructions in endoscopic and robotic surgery settings. To our knowledge, this is the first study to provide a model-agnostic, theoretically grounded approach to improving the safety of real-time endoscopic image SR.

Multimodal Large Language Models (MLLMs) have demonstrated remarkable potential in medical image analysis. However, their application in gastrointestinal endoscopy is currently hindered by two critical limitations: the misalignment between general model reasoning and standardized clinical cognitive pathways, and the lack of causal association between visual features and diagnostic outcomes. In this paper, we propose a novel Clinical-Cognitive-Aligned (CogAlign) framework to address these challenges. First, we endow the model with rigorous clinical analytical capabilities by constructing the hierarchical clinical cognition dataset and employing Supervised Fine-Tuning (SFT). Unlike conventional approaches, this strategy internalizes the hierarchical diagnostic logic of experts, ranging from anatomical localization and morphological evaluation to microvascular analysis, directly into the model. Second, to eliminate visual bias, we provide a theoretical analysis demonstrating that standard supervised tuning inevitably converges to spurious background correlations. Guided by this insight, we propose a counterfactual-driven reinforcement learning strategy to enforce causal rectification. By generating counterfactual normal samples via lesion masking and optimizing through clinical-cognition-centric rewards, we constrain the model to strictly ground its diagnosis in causal lesion features. Extensive experiments demonstrate that our approach achieves State-of-the-Art (SoTA) performance across multiple benchmarks, significantly enhancing diagnostic accuracy in complex clinical scenarios.

Predicting surgical needle trajectories from endoscopic video is critical for robot-assisted suturing, enabling anticipatory planning, real-time guidance, and safer motion execution. Existing methods that directly learn motion distributions from visual observations tend to overlook the sequential dependency among adjacent motion steps. Moreover, sparse waypoint annotations often fail to provide sufficient supervision, further increasing the difficulty of supervised or imitation learning methods. To address these challenges, we formulate image-based needle trajectory prediction as a sequential decision-making problem, in which the needle tip is treated as an agent that moves step by step in pixel space. This formulation naturally captures the continuity of needle motion and enables the explicit modeling of physically plausible pixel-wise state transitions over time. From this perspective, we propose SutureFormer, a goal-conditioned offline reinforcement learning framework that leverages sparse annotations to dense reward signals via cubic spline interpolation, encouraging the policy to exploit limited expert guidance while exploring plausible future motion paths. SutureFormer encodes variable-length clips using an observation encoder to capture both local spatial cues and long-range temporal dynamics, and autoregressively predicts future waypoints through actions composed of discrete directions and continuous magnitudes. To enable stable offline policy optimization from expert demonstrations, we adopt Conservative Q-Learning with Behavioral Cloning regularization. Experiments on a new kidney wound suturing dataset containing 1,158 trajectories from 50 patients show that SutureFormer reduces Average Displacement Error by 58.6% compared with the strongest baseline, demonstrating the effectiveness of modeling needle trajectory prediction as pixel-level sequential action learning.

The classification performance of deep neural networks relies strongly on access to large, accurately annotated datasets. In medical imaging, however, obtaining such datasets is particularly challenging since annotations must be provided by specialized physicians, which severely limits the pool of annotators. Furthermore, class boundaries can often be ambiguous or difficult to define which further complicates machine learning-based classification. In this paper, we want to address this problem and introduce a framework for mislabel detection in medical datasets. This is validated on the two largest, publicly available datasets for Video Capsule Endoscopy, an important imaging procedure for examining the gastrointestinal tract based on a video stream of lowresolution images. In addition, potentially mislabeled samples identified by our pipeline were reviewed and re-annotated by three experienced gastroenterologists. Our results show that the proposed framework successfully detects incorrectly labeled data and results in an improved anomaly detection performance after cleaning the datasets compared to current baselines.

Surgical future prediction, driven by real-time AI analysis of surgical video, is critical for operating room safety and efficiency. It provides actionable insights into upcoming events, their timing, and risks-enabling better resource allocation, timely instrument readiness, and early warnings for complications (e.g., bleeding, bile duct injury). Despite this need, current surgical AI research focuses on understanding what is happening rather than predicting future events. Existing methods target specific tasks in isolation, lacking unified approaches that span both short-term (action triplets, events) and long-term horizons (remaining surgery duration, phase transitions). These methods rely on coarse-grained supervision while fine-grained surgical action triplets and steps remain underexplored. Furthermore, methods based only on future feature prediction struggle to generalize across different surgical contexts and procedures. We address these limits by reframing surgical future prediction as state-change learning. Rather than forecasting raw observations, our approach classifies state transitions between current and future timesteps. We introduce SurgFUTR, implementing this through a teacher-student architecture. Video clips are compressed into state representations via Sinkhorn-Knopp clustering; the teacher network learns from both current and future clips, while the student network predicts future states from current videos alone, guided by our Action Dynamics (ActDyn) module. We establish SFPBench with five prediction tasks spanning short-term (triplets, events) and long-term (remaining surgery duration, phase and step transitions) horizons. Experiments across four datasets and three procedures show consistent improvements. Cross-procedure transfer validates generalizability.

Depth estimation is a foundational component for 3D reconstruction in minimally invasive endoscopic surgeries. However, existing monocular depth estimation techniques often exhibit limited performance to the varying illumination and complex textures of the surgical environment. While applying foundation models offers a promising approach to enhance the depth estimation performance, the domain gap between the natural images used for pre-training and the target endoscopic images leads to significant semantic perception deficiencies. In this study, EndoUFM is introduced as an unsupervised monocular depth estimation framework that innovatively \underline{U}tilizes dual Foundation Models for Endoscopic images, thereby enhancing the depth estimation performance by leveraging the powerful pre-learned priors. The framework features a novel adaptive fine-tuning strategy that incorporates Random Vector Low-Rank Adaptation (RVLoRA) to enhance model adaptability, and a Residual block based on Depthwise Separable Convolution (Res-DSC) to improve the capture of fine-grained local features. A mask-guided smoothness loss is also introduced to enforce depth consistency within anatomical structures. Extensive experiments on the SCARED, Hamlyn, SERV-CT, and EndoNeRF datasets confirm that our method achieves state-of-the-art performance while maintaining an efficient model size. This work contributes to augmenting surgeons' spatial perception during minimally invasive procedures, thereby enhancing surgical precision and safety, with crucial implications for augmented reality and navigation systems. Our code is available at https://github.com/RealMindyY/EndoUFM.

Endoscopic diagnosis is an iterative process in which clinicians acquire, compare, and verify local visual evidence before reaching a conclusion. Current AI systems do not adequately support this process because fine-grained evidence acquisition and multi-step reasoning remain weakly coupled, complicating reconciliation of image-derived findings with their textual interpretations. This gives rise to two failure modes, hallucinated evidence and uncorrected error accumulation, that undermine diagnostic reliability. We propose EndoCogniAgent, a closed-loop agentic framework that formulates endoscopic diagnosis as a controlled state update process for integrating complementary visual and textual evidence. At each reasoning round, a central planner selects an evidence acquisition action, specialized expert tools extract spatial and semantic observations as structured textual evidence, and a self-consistency validation mechanism examines this evidence along two dimensions, knowledge consistency against the input image and temporal consistency with prior validated findings, before updating the diagnostic state. Validated observations are admitted into the evolving state to condition subsequent planning, while insufficiently supported or conflicting findings are retained with corrective feedback that redirects the planner toward additional verification. We further introduce EndoAgentBench, a workflow-oriented benchmark comprising 6,132 question-answer pairs from 11 endoscopic datasets, to evaluate diagnostic agents across a comprehensive diagnostic chain, from fine-grained visual perception to high-level diagnostic reasoning. EndoCogniAgent achieves 85.23% overall accuracy on perception tasks and 71.13% clinical acceptance rate on reasoning tasks. Blinded clinician evaluation further shows consistent improvements in diagnostic response quality over the evaluated baselines.

This paper presents a method to efficiently classify the gastroenterologic section of images derived from Video Capsule Endoscopy (VCE) studies by exploring the combination of a Convolutional Neural Network (CNN) for classification with the time-series analysis properties of a Hidden Markov Model (HMM). It is demonstrated that successive time-series analysis identifies and corrects errors in the CNN output. Our approach achieves an accuracy of $98.04\%$ on the Rhode Island (RI) Gastroenterology dataset. This allows for precise localization within the gastrointestinal (GI) tract while requiring only approximately 1M parameters and thus, provides a method suitable for low power devices