Comparative Analysis of CNNs and Vision Transformers for Lesion Classification in Capsule Endoscopy

Video capsule endoscopy (VCE) enables high-resolution visualisation of the small bowel but remains constrained by manual review of thousands of frames, which is time-consuming and error-prone under class imbalance. This study investigates deep learning for automatic multiclass lesion classification in VCE, comparing two convolutional networks (ResNet-50, EfficientNet-B3) with two Vision Transformers (Swin, DeiT) on the public Kvasir-Capsule dataset (47,161 images; 11 classes). The pipeline comprises standard preprocessing, class-aware augmentation and adaptive data augmentation, stratified data partitioning, hyperparameter optimisation with Optuna, and evaluation using accuracy, precision, recall, and F1-score. DeiT achieved the best overall performance (accuracy = 0.98; F1 = 0.96), with strong class-wise results in clinically salient categories (e.g., ulcer, fresh blood, angiectasia), indicating effective modelling of long-range dependencies and subtle patterns. We further assess computational feasibility by reporting training configuration and indicative inference time per image, supporting potential integration into assisted reading workflows. Limitations include reliance on a single public dataset, pronounced class imbalance, and the absence of prospective clinical validation, which may affect generalisability. These findings position Transformer-based models as promising candidates for VCE decision support, while underscoring the need for future work on (i) multicentric datasets and external validation, (ii) comprehensive statistical analysis with confidence intervals and robust baselines under imbalance, and (iii) prospective studies quantifying end-to-end impact on reading time and diagnostic safety.