Investing in Iterative Scopes

Nan Li
Obvious Ventures
Published in
4 min readAug 3, 2021

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Bringing personalized medicine to gastroenterology

Gastrointestinal diseases are a sleeping giant in the world of chronic illnesses. Upwards of 70 million Americans are diagnosed with some type of GI disorder each year — twice as many people as those living with diabetes. The most severe subset of these afflictions include inflammatory bowel disease (IBD), ulcerative colitis (UC), Crohn’s Disease (CD), and colorectal cancer (CRC). These diseases constitute massive cost drivers to the healthcare system and are life threatening issues. Despite the prevalence of this disease area, progress on addressing this illness severely lags other prominent disease areas such as cancer or diabetes.

One of the key issues in the current standard of care is diagnosis and patient stratification. The primary mechanism for diagnosis and ongoing monitoring of GI disease involve an endoscopic exam that feeds a live video out for interpretation by a GI physician. These physicians are asked to internalize a very complex imaging type: a 360-degree video feed generated by a scope that traverses through a segment of the colon over time.

Out of this video feed, physicians are asked to assess nuanced clinical features across the explored physiology, and to pare that down to a severity rating of 0–3. This is the level of granularity of hotel customer satisfaction surveys, and grossly dismisses the nuanced biological features that are captured by the endoscopic exam.

As a result, the endoscopic exam is one of the most subjective diagnostic tools in all of modern medicine. This creates downstream issues that lead to missed diagnoses, improper patient stratification, and perhaps even a misunderstanding of the types of GI diseases that are out there in the first place. The nature of this problem is highly applicable for AI as readouts can be augmented with computer vision annotations. With increasing momentum behind AI applications in medicine, GI disease holds a currently untapped opportunity to build an industry-defining company.

Iterative Scopes: Advancing computer vision in GI disease

Iterative Scopes has trained computer vision models to interpret this video feed and annotate the field of view with relevant biological features in real time. As we have seen in other applications of AI in medical imaging, including Recursion Pharma which takes this approach to cell phenotyping, computational capabilities vastly outpace that of humans in accuracy, nuance, and speed.

Over the past three years, the company has built out the world’s best AI capabilities in GI and is starting to convert this into significant commercial traction. As the endoscopic readout is the gold standard for disease diagnosis and treatment, the applications of the company spans across many aspects of clinical care and drug discovery.

A Play in Three Acts

We see the journey ahead for the company as a multi-staged process to advance the standard of care across many aspects of gastroenterology. Iterative has already engaged with leading Provider and Pharma partners to realize their vision for what the future holds and will continue to make progress in these key areas.

  1. Clinical Diagnostic Support. Through an exclusive partnership with Provation Medical, Iterative will roll out edge deployed computer vision systems to assist with patient diagnostics and screening. The product can annotate problematic polyps and other biological features of interest during endoscopic scans.
  2. Clinical Trial Recruiting. By leveraging the clinical footprint of the diagnostic support tool, Iterative is in a unique position to identify patients of interest through the standard care journey. These patients can be flagged for clinical trial eligibility based on algorithmic classification in addition to clinical data directly pulled in from the EHR.
  3. Digital Biomarker for GI. Through widespread deployment of the product and the collection of longitudinal patient data, Iterative has the ability to establish a new industry standard for diagnosis and patient identification. This has incredible potential to serve as a useful for clinical trial design and serving as a key patient inclusion criteria for therapeutics. In addition, this more nuanced view of patients and disease progression can lead to better clinical decision support and therapy triage.

All of this to state the obvious: there is incredible potential and there is an incredible amount of work to be done. That is what we look for at Obvious and why we are so thrilled to lead the Series A of Iterative Scopes. We believe that Iterative truly has the potential to change the standard of care in an entire disease area. The company has made tremendous progress towards that ambitious goal and we are excited to support them on the journey towards that ambitious vision.

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Nan Li
Obvious Ventures

GP @ Obvious; technology, music, culture enthusiast