EndoAgent: A Memory-Guided Reflective Agent for Intelligent Endoscopic Vision-to-Decision Reasoning

Abstract: Developing general AI systems to support endoscopic image diagnosis is an emerging research priority. Existing methods based on large-scale pretraining often lack unified coordination across tasks and struggle to handle the multi-step processes required in complex clinical workflows. While AI agents have shown promise in flexible instruction parsing and tool integration across domains, their potential in endoscopy remains underexplored. To address this gap, we propose EndoAgent, the first memory-guided agent for vision-to-decision endoscopic analysis that integrates iterative reasoning with adaptive tool selection and collaboration. Built on a dual-memory design, it enables sophisticated decision-making by ensuring logical coherence through short-term action tracking and progressively enhancing reasoning acuity through long-term experiential learning. To support diverse clinical tasks, EndoAgent integrates a suite of expert-designed tools within a unified reasoning loop. We further introduce EndoAgentBench, a benchmark of 5,709 visual question-answer pairs that assess visual understanding and language generation capabilities in realistic scenarios. Extensive experiments show that EndoAgent consistently outperforms both general and medical multimodal models, exhibiting its strong flexibility and reasoning capabilities.