Video capsule endoscopy has transformed gastrointestinal endoscopy (GIE) diagnostics by offering a non-invasive method for capturing detailed images of the gastrointestinal tract, enabling early disease detection. However, its potential is limited by the sheer volume of images generated during the imaging procedure, which can take anywhere from 6-8 hours and often produce up to 1 million images, necessitating automated analysis. Additionally, the variability of these images, combined with the need for expert annotations and the scarcity of large, high-quality labeled datasets, constrains the effectiveness of current medical image analysis models. To address this, we introduce a novel large GIE dataset, called EndoExtend24, created by merging ten existing public and private datasets, ensuring patient integrity across splits. EndoExtend24 includes over 226,000 labeled images, as well as dynamic class mappings, which allow unified training across datasets with differing labeling granularity, supporting up to 123 distinct pathological findings. Further, we propose to leverage domain adaptive pre-training of foundation models trained with self-supervision on generic image data, to adapt
White light endoscopy is the clinical gold standard for detecting diseases in the gastrointestinal tract. Most applications involve identifying visual abnormalities in tissue color, texture, and shape. Unfortunately, the contrast of these features is often subtle, causing many clinically relevant cases to go undetected. To overcome this challenge, we introduce Multi-contrast Laser Endoscopy (MLE): a platform for widefield clinical imaging with rapidly tunable spectral, coherent, and directional illumination. We demonstrate three capabilities of MLE: enhancing tissue chromophore contrast with multispectral diffuse reflectance, quantifying blood flow using laser speckle contrast imaging, and characterizing mucosal topography using photometric stereo. We validate MLE with benchtop models, then demonstrate MLE in vivo during clinical colonoscopies. MLE images from 31 polyps demonstrate an approximate three-fold improvement in contrast and a five-fold improvement in color difference compared to white light and narrow band imaging. With the ability to reveal multiple complementary types of tissue contrast while seamlessly integrating into the clinical environment, MLE shows promise as an
Gastrointestinal diseases impose a growing global health burden, and endoscopy is a primary tool for early diagnosis. However, routine endoscopic image interpretation still suffers from missed lesions and limited efficiency. Although AI-assisted diagnosis has shown promise, existing models often lack generalizability, adaptability, robustness, and scalability because of limited medical data, domain shift, and heterogeneous annotations. To address these challenges, we develop RATNet, a foundation model for gastrointestinal endoscopy imaging based on analogical reasoning. RATNet acquires and transfers knowledge from heterogeneous expert annotations across five gastrointestinal endoscopy datasets through a cyclic pre-training strategy. Its architecture consists of an encoder, a relevance-knowledge acquisition and transfer (RAT) module, a projector, and a multi-task head, and supports fine-tuning, linear probing, and zero-shot transfer. Evaluations show that RATNet outperforms existing foundation models, including GastroNet and GastroVision, across six scenarios: diagnosis of common gastrointestinal diseases, few-shot learning for rare diseases, zero-shot transfer to new medical sites,
Automatic speech recognition (ASR) is a critical interface for human-AI interaction in gastrointestinal endoscopy, yet its reliability in real-world clinical settings is limited by domain-specific terminology and complex acoustic conditions. Here, we present EndoASR, a domain-adapted ASR system designed for real-time deployment in endoscopic workflows. We develop a two-stage adaptation strategy based on synthetic endoscopy reports, targeting domain-specific language modeling and noise robustness. In retrospective evaluation across six endoscopists, EndoASR substantially improves both transcription accuracy and clinical usability, reducing character error rate (CER) from 20.52% to 14.14% and increasing medical term accuracy (Med ACC) from 54.30% to 87.59%. In a prospective multi-center study spanning five independent endoscopy centers, EndoASR demonstrates consistent generalization under heterogeneous real-world conditions. Compared with the baseline Paraformer model, CER is reduced from 16.20% to 14.97%, while Med ACC is improved from 61.63% to 84.16%, confirming its robustness in practical deployment scenarios. Notably, EndoASR achieves a real-time factor (RTF) of 0.005, significa
Capsule endoscopy is a method to capture images of the gastrointestinal tract and screen for diseases which might remain hidden if investigated with standard endoscopes. Due to the limited size of a video capsule, embedding AI models directly into the capsule demands careful consideration of the model size and thus complicates anomaly detection in this field. Furthermore, the scarcity of available data in this domain poses an ongoing challenge to achieving effective anomaly detection. Thus, this work introduces an ensemble strategy to address this challenge in anomaly detection tasks in video capsule endoscopies, requiring only a small number of individual neural networks during both the training and inference phases. Ensemble learning combines the predictions of multiple independently trained neural networks. This has shown to be highly effective in enhancing both the accuracy and robustness of machine learning models. However, this comes at the cost of higher memory usage and increased computational effort, which quickly becomes prohibitive in many real-world applications. Instead of applying the same training algorithm to each individual network, we propose using various loss fu
During their travel through the gastrointestinal tract, ingestible antennas encounter detuning in their impedance response due to varying electromagnetic properties of the surrounding tissues. This paper investigates the possibility of using this impedance detuning to detect in which segment of the gastrointestinal tract - stomach, small intestine, or large intestine - the capsule is located. Meandered dipole antennas operating in the 433 MHz Industrial, Scientific, and Medical Band are designed for this purpose. The antennas conform to the inner surface of 3D-printed polylactic-acid capsules with a shell thickness of 0.6 or 0.4 mm. The impedance response is first optimized numerically in a homogeneous cylindrical phantom with time-averaged electromagnetic properties. The magnitude and the phase of the reflection coefficient are then obtained in different tissues and compared with simulations and measurements. The experimental demonstration is carried out first using tissue-mimicking liquids and then in a recently deceased ex vivo porcine model. The minimum change in the phase between different gastrointestinal tissues was determined to be around 10 degrees in the porcine model, in
For early diagnosis of malignancies in the gastrointestinal tract, surveillance endoscopy is increasingly used to monitor abnormal tissue changes in serial examinations of the same patient. Despite successes with optical biopsy for in vivo and in situ tissue characterisation, biopsy retargeting for serial examinations is challenging because tissue may change in appearance between examinations. In this paper, we propose an inter-examination retargeting framework for optical biopsy, based on an image descriptor designed for matching between endoscopic scenes over significant time intervals. Each scene is described by a hierarchy of regional intensity comparisons at various scales, offering tolerance to long-term change in tissue appearance whilst remaining discriminative. Binary coding is then used to compress the descriptor via a novel random forests approach, providing fast comparisons in Hamming space and real-time retargeting. Extensive validation conducted on 13 in vivo gastrointestinal videos, collected from six patients, show that our approach outperforms state-of-the-art methods.
Solutions to vision tasks in gastrointestinal endoscopy (GIE) conventionally use image encoders pretrained in a supervised manner with ImageNet-1k as backbones. However, the use of modern self-supervised pretraining algorithms and a recent dataset of 100k unlabelled GIE images (Hyperkvasir-unlabelled) may allow for improvements. In this work, we study the fine-tuned performance of models with ResNet50 and ViT-B backbones pretrained in self-supervised and supervised manners with ImageNet-1k and Hyperkvasir-unlabelled (self-supervised only) in a range of GIE vision tasks. In addition to identifying the most suitable pretraining pipeline and backbone architecture for each task, out of those considered, our results suggest three general principles. Firstly, that self-supervised pretraining generally produces more suitable backbones for GIE vision tasks than supervised pretraining. Secondly, that self-supervised pretraining with ImageNet-1k is typically more suitable than pretraining with Hyperkvasir-unlabelled, with the notable exception of monocular depth estimation in colonoscopy. Thirdly, that ViT-Bs are more suitable in polyp segmentation and monocular depth estimation in colonosco
Multimodal Large Language Models (MLLMs) show promise in gastroenterology, yet their performance against comprehensive clinical workflows and human benchmarks remains unverified. To systematically evaluate state-of-the-art MLLMs across a panoramic gastrointestinal endoscopy workflow and determine their clinical utility compared with human endoscopists. We constructed GI-Bench, a benchmark encompassing 20 fine-grained lesion categories. Twelve MLLMs were evaluated across a five-stage clinical workflow: anatomical localization, lesion identification, diagnosis, findings description, and management. Model performance was benchmarked against three junior endoscopists and three residency trainees using Macro-F1, mean Intersection-over-Union (mIoU), and multi-dimensional Likert scale. Gemini-3-Pro achieved state-of-the-art performance. In diagnostic reasoning, top-tier models (Macro-F1 0.641) outperformed trainees (0.492) and rivaled junior endoscopists (0.727; p>0.05). However, a critical "spatial grounding bottleneck" persisted; human lesion localization (mIoU >0.506) significantly outperformed the best model (0.345; p<0.05). Furthermore, qualitative analysis revealed a "fluen
The escalating global mortality and morbidity rates associated with gastrointestinal (GI) bleeding, compounded by the complexities and limitations of traditional endoscopic methods, underscore the urgent need for a critical review of current methodologies used for addressing this condition. With an estimated 300,000 annual deaths worldwide, the demand for innovative diagnostic and therapeutic strategies is paramount. The introduction of Video Capsule Endoscopy (VCE) has marked a significant advancement, offering a comprehensive, non-invasive visualization of the digestive tract that is pivotal for detecting bleeding sources unattainable by traditional methods. Despite its benefits, the efficacy of VCE is hindered by diagnostic challenges, including time-consuming analysis and susceptibility to human error. This backdrop sets the stage for exploring Machine Learning (ML) applications in automating GI bleeding detection within capsule endoscopy, aiming to enhance diagnostic accuracy, reduce manual labor, and improve patient outcomes. Through an exhaustive analysis of 113 papers published between 2008 and 2023, this review assesses the current state of ML methodologies in bleeding det
Video Capsule Endoscopy (VCE) has become an indispensable diagnostic tool for gastrointestinal (GI) disorders due to its non-invasive nature and ability to capture high-resolution images of the small intestine. However, the enormous volume of data generated during a single procedure makes manual inspection labor-intensive, time-consuming, and prone to inter-observer variability. Automated analysis using deep learning offers a promising solution, but its effectiveness is often limited by data imbalance and the high cost of labeled medical data. In this work, we propose a novel framework that combines self-supervised learning through a U-Net-based masked autoencoder with supervised feature extraction using EfficientNet-B7 for multi-class abnormality classification in VCE images. The U-Net model is first trained in a self-supervised manner using Gaussian noise removal and masked reconstruction to learn robust visual representations without requiring annotations. The learned encoder features are then fused with EfficientNet-B7 features to form a rich, discriminative representation for classification. We evaluate our approach on the Capsule Vision 2024 Challenge dataset consisting of te
Endoscopy serves as an essential procedure for evaluating the gastrointestinal (GI) tract and plays a pivotal role in identifying GI-related disorders. Recent advancements in deep learning have demonstrated substantial progress in detecting abnormalities through intricate models and data augmentation methods.This research introduces a novel approach to enhance classification accuracy using 8,000 labeled endoscopic images from the Kvasir dataset, categorized into eight distinct classes. Leveraging EfficientNetB3 as the backbone, the proposed architecture eliminates reliance on data augmentation while preserving moderate model complexity. The model achieves a test accuracy of 94.25%, alongside precision and recall of 94.29% and 94.24% respectively. Furthermore, Local Interpretable Model-agnostic Explanation (LIME) saliency maps are employed to enhance interpretability by defining critical regions in the images that influenced model predictions. Overall, this work highlights the importance of AI in advancing medical imaging by combining high classification accuracy with interpretability.
Endoscopic procedures such as esophagogastroduodenoscopy (EGD) and colonoscopy play a critical role in diagnosing and managing gastrointestinal (GI) disorders. However, the documentation burden associated with these procedures place significant strain on gastroenterologists, contributing to inefficiencies in clinical workflows and physician burnout. To address this challenge, we propose a novel automated report generation model that leverages a transformer-based vision encoder and text decoder within a two-stage training framework. In the first stage, both components are pre-trained on image/text caption pairs to capture generalized vision-language features, followed by fine-tuning on images/report pairs to generate clinically meaningful findings. Our approach not only streamlines the documentation process but also holds promise for reducing physician workload and improving patient care.
Medical Visual Question Answering (MedVQA) is a promising field for developing clinical decision support systems, yet progress is often limited by the available datasets, which can lack clinical complexity and visual diversity. To address these gaps, we introduce Kvasir-VQA-x1, a new, large-scale dataset for gastrointestinal (GI) endoscopy. Our work significantly expands upon the original Kvasir-VQA by incorporating 159,549 new question-answer pairs that are designed to test deeper clinical reasoning. We developed a systematic method using large language models to generate these questions, which are stratified by complexity to better assess a model's inference capabilities. To ensure our dataset prepares models for real-world clinical scenarios, we have also introduced a variety of visual augmentations that mimic common imaging artifacts. The dataset is structured to support two main evaluation tracks: one for standard VQA performance and another to test model robustness against these visual perturbations. By providing a more challenging and clinically relevant benchmark, Kvasir-VQA-x1 aims to accelerate the development of more reliable and effective multimodal AI systems for use i
Conventional Endoscopy (CE) and Wireless Capsule Endoscopy (WCE) are known tools for diagnosing gastrointestinal (GI) tract disorders. Detecting the anatomical location of GI tract can help clinicians to determine a more appropriate treatment plan, can reduce repetitive endoscopy and is important in drug-delivery. There are few research that address detecting anatomical location of WCE and CE images using classification, mainly because of difficulty in collecting data and anotating them. In this study, we present a few-shot learning method based on distance metric learning which combines transfer-learning and manifold mixup scheme for localizing endoscopy frames and can be trained on few samples. The manifold mixup process improves few-shot learning by increasing the number of training epochs while reducing overfitting, as well as providing more accurate decision boundaries. A dataset is collected from 10 different anatomical positions of human GI tract. Two models were trained using only 78 CE and 27 WCE annotated frames to predict the location of 25700 and 1825 video frames from CE and WCE, respectively. In addition, we performed subjective evaluation using nine gastroenterologis
The integration of artificial intelligence (AI) in medical diagnostics represents a significant advancement in managing upper gastrointestinal (GI) cancer, a major cause of global cancer mortality. Specifically for gastric cancer (GC), chronic inflammation causes changes in the mucosa such as atrophy, intestinal metaplasia (IM), dysplasia and ultimately cancer. Early detection through endoscopic regular surveillance is essential for better outcomes. Foundation models (FM), which are machine or deep learning models trained on diverse data and applicable to broad use cases, offer a promising solution to enhance the accuracy of endoscopy and its subsequent pathology image analysis. This review explores the recent advancements, applications, and challenges associated with FM in endoscopy and pathology imaging. We started by elucidating the core principles and architectures underlying these models, including their training methodologies and the pivotal role of large-scale data in developing their predictive capabilities. Moreover, this work discusses emerging trends and future research directions, emphasizing the integration of multimodal data, the development of more robust and equitab
Domain Generalization is a challenging topic in computer vision, especially in Gastrointestinal Endoscopy image analysis. Due to several device limitations and ethical reasons, current open-source datasets are typically collected on a limited number of patients using the same brand of sensors. Different brands of devices and individual differences will significantly affect the model's generalizability. Therefore, to address the generalization problem in GI(Gastrointestinal) endoscopy, we propose a multi-domain GI dataset and a light, plug-in block called InvNorm(Invertible Normalization), which could achieve a better generalization performance in any structure. Previous DG(Domain Generalization) methods fail to achieve invertible transformation, which would lead to some misleading augmentation. Moreover, these models would be more likely to lead to medical ethics issues. Our method utilizes normalizing flow to achieve invertible and explainable style normalization to address the problem. The effectiveness of InvNorm is demonstrated on a wide range of tasks, including GI recognition, GI object detection, and natural image recognition.
Wireless capsule endoscopy (WCE) is a non-invasive diagnostic procedure that enables visualization of the gastrointestinal (GI) tract. Deep learning-based methods have shown effectiveness in disease screening using WCE data, alleviating the burden on healthcare professionals. However, existing capsule endoscopy classification methods mostly rely on pre-defined categories, making it challenging to identify and classify out-of-distribution (OOD) data, such as undefined categories or anatomical landmarks. To address this issue, we propose the Endoscopy Out-of-Distribution (EndoOOD) framework, which aims to effectively handle the OOD detection challenge in WCE diagnosis. The proposed framework focuses on improving the robustness and reliability of WCE diagnostic capabilities by incorporating uncertainty-aware mixup training and long-tailed in-distribution (ID) data calibration techniques. Additionally, virtual-logit matching is employed to accurately distinguish between OOD and ID data while minimizing information loss. To assess the performance of our proposed solution, we conduct evaluations and comparisons with 12 state-of-the-art (SOTA) methods using two publicly available datasets
Recently, the amount of GI tract datasets is introduced more and more by gathering from contests and challenges. The most common task needs to solve that is to classify images from the GI tract into various classes. However, the contributions of the existing approaches exhibit lots of limitations. In this paper, we aim to develop a computer-aided diagnosis system to classify the pathological findings in endoscopy images, the system can classify some common pathologies including polyps, esophagitis, and ulcerative -- colitis. To evaluate the proposed work, we use the public dataset which is Hyper--Kvasir instead of gathering the data. The key idea of our system is to develop self-supervised learning based on the Barlow Twins framework with a downstream task which is an endoscopy image classification integrated with triplet loss and focal loss functions. The self-supervision framework and focal loss function are used to overcome class-imbalanced data, while the triplet loss function is to tackle the domain-specific properties in endoscopy images which are inter/intra-class problems. An extensive experimental study on the pathological finding images in the Hyper--Kvasir dataset has sh
Due to the aging of the world population and westernization of lifestyles, the prevalence of neurodegenerative diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD) is rapidly rising and is expected to put a strong socioeconomic burden on health systems worldwide. Due to the limited success of clinical trials of therapies against neurodegenerative diseases, research has extended its scope to a systems medicine point of view, with a particular focus on the gastrointestinal-brain axis as a potential main actor in disease development and progression. Microbiome as well as metabolome studies along the gastrointestinal-brain axis have already revealed important insights into disease pathomechanisms. Both the microbiome and metabolome can be easily manipulated by dietary and lifestyle interventions, and might thus offer novel, readily available therapeutic options to prevent the onset as well as the progression of PD and AD. This review summarizes our current knowledge on the association between microbiota, metabolites, and neurodegeneration in light of the gastrointestinal-brain axis. In this context, we also illustrate state-of-the art methods of microbiome and metabol