Autonomous endoscopic navigation requires the policy model to predict actions from texture-poor monocular observations, make safe control decisions, and retain evidence of lesions after they leave the field of view. Existing vision-language-action (VLA) models primarily rely on visual appearance and short-term context, limiting geometric grounding and episode-level reporting.

We introduce StenoVLA-3D, a 3D-aware VLA framework for navigating through stenotic regions. We integrate point-maps into the Cosmos-Reason 2 backbone through learned geometry-gated fusion, and also propose a temporal state branch to model traversal progress.

Our reasoning-and-action backbone predicts grounded reasoning with actions, while dedicated heads estimate stenosis shape and generate the final lesion report. We further introduce EndoCausal, an episode-level dataset with lesion annotations, actions, and temporally grounded reasoning.

On 40 held-out recorded test episodes, StenoVLA-3D reaches 95.2% semantic accuracy and 83.4% action accuracy. On the physical 3-DoF endoscope, it attains 88.9% and 77.8% task success in esophageal and colonic phantoms (36 trials each), substantially outperforming the evaluated baselines.