arXiv:2508.07292v4 Announce Type: replace

Abstract: 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.