(118 days)
No
The device description focuses on mechanical and ergonomic improvements to a standard endoscope, with no mention of software, image analysis, or any terms related to AI/ML.
Yes
The device is intended for "endoscopic treatment," which implies a therapeutic function beyond just diagnosis or visualization. While it's also used for visualization and diagnosis, the "treatment" aspect makes it a therapeutic device.
Yes
Brief Explanation: The "Intended Use / Indications for Use" section explicitly states that the device is intended for "observation, diagnosis, and endoscopic treatment" of the upper digestive tract. The term "diagnosis" clearly indicates its function as a diagnostic device.
No
The device description clearly details physical components like endoscopes, ports, valves, and adapters, indicating it is a hardware device with potential software control, not a software-only device.
Based on the provided information, this device is not an IVD (In Vitro Diagnostic).
Here's why:
- IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
- Device Function: The description clearly states that the Fujinon GS Gastroscopes are used for the visualization and endoscopic treatment of the upper digestive tract. This involves inserting the device directly into the body to observe and potentially treat tissues in vivo (within the living organism).
- Lack of Sample Analysis: There is no mention of the device analyzing samples taken from the patient. Its primary function is direct observation and intervention within the body.
Therefore, the Fujinon GS Gastroscopes are considered a medical device used for endoscopy, not an in vitro diagnostic device.
N/A
Intended Use / Indications for Use
The device is intended for the visualization of the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb.
Product codes
78 FDS
Device Description
The Fujinon GS Gastroscopes are medical endoscopes used for visualization of the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb.
The G5 Gastroscopes are offered in a 200 and 400 series. The EG-250WR5 represents the G5 Gastrooscope 200 series and the EG-450WR5 represents the G5 Gastroscope 400 series.
The G5 Gastroscopes include minor changes that improve the useability, ergonomics, and cleaning of the devices. The G5 scopes do not have an L-Port. The L-port functioned as a lens wash port. Doctors had the option to take a syringe to inject a fluid to use it as a high pressure wash for the lens. This function was eliminated because demand was low and it was rarely used by the surgeons.
A G5 forceps inlet port was modified. The new port is smaller and comes with a rubber cap. The new design helps increase suction and reduces leakage.
The jet wash line check valve was removed. Internal check valves were removed to eliminate the potential for clogging and to facilitate cleaning, disinfection. The valves are now external and removable.
The suction and air/water cylinders and valves were upgraded. They were updated to accommodate the new valves. The function of the valves is the same.
The G5 Gastroscopes also feature the addition of the FOV, which is the rubber forceps inlet valve cover. This helps create a watertight seal when the endoscope is used. Upgrade to CA-500 cleaning adaptor. The cleaning adaptor allows the scope to be connected to tubes for cleaning.
The G5 Gastroscopes are used with the same processors, monitors, hard copy units, and carts as the predicate devices. Each Gastroscope is packaged in a protective carrying case with lens cleaner, silicon oil, forceps valve, waterproof cap, S connector cap, protective cap, adapters, valves, and the Operation Manual.
The Fujinon G5 Gastroscopes are used in conjunction with other perified in the Operation Manual such as:
- Light Source / Processor / Cart / Data Keyboard / Foot Switch / Monitor / Video Printer
- Camera and Hard Copy Unit / VCR / Electrosurgical Instruments
Mentions image processing
Not Found
Mentions AI, DNN, or ML
Not Found
Input Imaging Modality
Not Found
Anatomical Site
upper digestive tract, esophagus, stomach, and duodenal bulb
Indicated Patient Age Range
Not Found
Intended User / Care Setting
Not Found
Description of the training set, sample size, data source, and annotation protocol
Not Found
Description of the test set, sample size, data source, and annotation protocol
Not Found
Summary of Performance Studies
The subject device has been subjected to and passed EMC testing requirements. The patient contact materials in the Gastroscopes are identical to the materials used in the predicate device.
Key Metrics
Not Found
Predicate Device(s)
Reference Device(s)
Predetermined Change Control Plan (PCCP) - All Relevant Information
Not Found
§ 876.1500 Endoscope and accessories.
(a)
Identification. An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.(b)
Classification —(1)Class II (special controls). The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.
0
510 (k)
NOV 2 4 2004
Date Prepared [21 CFR 807.92(a)(1)]
July 21, 2004 [Amended October 29, 2004]
Submitter's Information [21 CFR 807.92(a)(1)]
Joseph M. Azary C/o Fujinon Inc. 543 Long Hill Avenue Shelton, CT. 06484
Azary Technologies has received authorization to submit this 510(k) on behalf of the sponsor Fujinon Inc., 10 High Point Drive, Wayne, NJ 07470, Establishment Registration# 2431293.
Trade Name, Common Name, Classification [21 CFR 807.92(a)(2)]
The device trade names are: Fujinon G5 Gastroscopes Common Name: Gastroscope Classification: Class II, 21 CFR 876.1500, FDS
Predicate Device [21 CFR 807.92(a)(3)]
The G5 changes were described and cleared by FDA in the 510(k) submission for the Fujinon Double Balloon Enteroscopy System - K040048.
This 510(k) captures some minor design changes that have occurred during the evolution of the product line resulting in the G5 family of scopes. Although the changes are believed to be minor, the 510(k) is being submitted to account for "design creep" and to ensure that FDA has the most current information concerning the Fuiinon Gastroscopes.
The subject devices have the same indications for use, composition of patient contact materials, viewing direction, image size, and reprocessing/sterilization method as the predicates. The subject devices use the same processors and peripherals as the predicate device.
The main differences between the subject devices and predicate devices are as follows:
- . Minor differences with observation range, field of view, diameter, bending capacity, and length.
- . The subject device includes the G5 upgrade, which is characterized by the following minor differences:
- o The L-Port has been eliminated. The L-port functioned as a lens wash port . Doctors had the option to take a syringe to inject a fluid to use it as a high pressure wash for the lens.
1
K c 4/4 c if
by c of cy
This function was eliminated because demand was low and it was rarely used by the surgeons.
- A G5 forceps inlet port was modified. The new port is smaller and comes with a rubber o cap. The smaller port and rubber cap help increase suction and reduce leakage.
- The jet wash line check valve was removed. Internal check valves were removed to elimi-0 nate the potential for clogging and to facilitate cleaning, disinfection, and sterilization. The valves are now external and removable.
- The suction and air/water cylinders and valves were upgraded. They were updated to aco commodate the new valves. The function of the valves is the same.
- Addition of the FOV, which is the rubber forceps inlet valve cover. This helps create a wao tertight seal when the endoscope is used.
- Upgrade to CA-500 cleaning adaptor. The cleaning adaptor allows the scope to be con-0 nected to tubes for cleaning.
Description of the Device [21 CFR 807.92(a)(4)]
The Fujinon GS Gastroscopes are medical endoscopes used for visualization of the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb.
The G5 Gastroscopes are offered in a 200 and 400 series. The EG-250WR5 represents the G5 Gastrooscope 200 series and the EG-450WR5 represents the G5 Gastroscope 400 series.
The G5 Gastroscopes include minor changes that improve the useability, ergonomics, and cleaning of the devices. The G5 scopes do not have an L-Port. The L-port functioned as a lens wash port. Doctors had the option to take a syringe to inject a fluid to use it as a high pressure wash for the lens. This function was eliminated because demand was low and it was rarely used by the surgeons.
A G5 forceps inlet port was modified. The new port is smaller and comes with a rubber cap. The new design helps increase suction and reduces leakage.
The jet wash line check valve was removed. Internal check valves were removed to eliminate the potential for clogging and to facilitate cleaning, disinfection. The valves are now external and removable.
The suction and air/water cylinders and valves were upgraded. They were updated to accommodate the new valves. The function of the valves is the same.
The G5 Gastroscopes also feature the addition of the FOV, which is the rubber forceps inlet valve cover. This helps create a watertight seal when the endoscope is used. Upgrade to CA-500 cleaning adaptor. The cleaning adaptor allows the scope to be connected to tubes for cleaning.
The G5 Gastroscopes are used with the same processors, monitors, hard copy units, and carts as the predicate devices. Each Gastroscope is packaged in a protective carrying case with lens cleaner, silicon oil, forceps valve, waterproof cap, S connector cap, protective cap, adapters, valves, and the Operation Manual.
The Fujinon G5 Gastroscopes are used in conjunction with other perified in the Operation Manual such as:
- Light Source / Processor / Cart / Data Keyboard / Foot Switch / Monitor / Video Printer .
2
19 3 af 4
- • Camera and Hard Copy Unit / VCR / Electrosurgical Instruments
ons for EG-450WR5 and EG-250WR5
| Specifications for EG-450WR5 and EG-250WR5 | |||
|---|---|---|---|
| EG-450WR5 | EG-250WR5 | ||
| Viewing Direction | Forward | Forward | |
| Observation Range | 5-100mm | 7-100mm | |
| Field of View | 140 degrees | 140 degrees | |
| Image Size | Super Image | Super Image | |
| Distal End Diameter | 9.4mm | 9.4mm | |
| Flexible Portion Diameter | 9.4mm | 9.4mm | |
| Bending Capacity UP | 210 degrees | 210 degrees | |
| Bending Capacity DOWN | 90 degrees | 90 degrees | |
| Bending Capacity LEFT | 100 degrees | 100 degrees | |
| Bending Capacity RIGHT | 100 degrees | 100 degrees | |
| Forceps Channel Diameter | 2.8mm | 2.8mm | |
| Working Length | 1100mm | 1100mm | |
| Total Length | 1400mm | 1400mm | |
| EG-450WR5 | EG-250WR5 | ||
| Material of Outer Lines (G1) | LaSf-n17 | LaSf-n17 | |
| Lens Diameter (mm) | 2.2 | 2.2 | |
| Electronic Video Imaging System | Total Pixels | 411,988 | 411,988 |
| Pixels per square millimeter | 83,892 | 83.892 | |
| Size of Pixel (H*V mm) | $0.0032*0.003725$ | $0.0032*0.003725$ | |
| Active area of CCD chip (H*V mm) | $2.458*1.840$ | $2.458*1.840$ | |
| Type of CCD chip | Interline Color | ||
| Chip | Interline Color | ||
| Chip | |||
| Image Quality Resolution (lines / mm) - Near Point | 11.1 lines/mm | ||
| (6mm) | 10.0 lines/mm | ||
| (7mm) | |||
| Image Quality Resolution (lines/mm) - Far Point | 0.91 lines/mm | ||
| (100mm) | 0.91 lines/mm | ||
| (100mm) | |||
| Magnification (specify monitor size and type used for this specification) | 24 (5mm) at 14 | ||
| inch monitor | 24 (5mm) at 14 | ||
| inch monitor | |||
| Focal Length | 1.206 | 1.206 |
3
Intended Use [21 CFR 807.92(a)(5)]
A 24 2043
pg 4 of 7
The device is intended for the visualization of the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb.
Technological Characteristics [21 CFR 807.92(a)(6)]
Fujinon, Inc. believes that the subject device is substantially equivalent to the predicate device. The subject device have the same indications for use, composition of patient contact material, viewing direction, image size, and reprocessing/sterilization method as the predicate. The subject devices use the same processors and peripherals as the predicate devices.
The main differences are the minor changes associated with the G5 upgrade. The G5 changes were previously cleared by FDA in the 510(k) submission for the Fujinon Double Balloon Enteroscopy System -K040048.
Performance Data [21 CFR 807.92(b)(1)]
The subject device has been subjected to and passed EMC testing requirements. The patient contact materials in the Gastroscopes are identical to the materials used in the predicate device.
Conclusion [21 CFR 807.92(b)(3)]
We believe the changes are minor and conclude that the subject devices are as safe and effective as the predicate devices.
4
DEPARTMENT OF HEALTH & HUMAN SERVICES
Image /page/4/Picture/12 description: The image shows the logo for the Department of Health & Human Services (HHS). The logo consists of a stylized eagle with three lines representing its body and wings. The eagle is enclosed in a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter of the circle.
Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850
NOV 2 4 2004
Fujinon, Inc. c/o Joseph M. Azary Azary Technologies™, LLC P.O. Box 2156 HUNTINGTON CT 06484
Re: K042043
Trade/Device Name: Fujinon Inc. G5 Gastroscopes Regulation Number: 21 CFR §876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: 78 FDS Dated: October 28, 2004 Received: November 1, 2004
Dear Mr. Azary:
We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.
If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.
Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.
5
This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.
If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:
| 21 CFR 876.xxxx | (Gastroenterology/Renal/Urology) | 240-276-0115 |
|---|---|---|
| 21 CFR 884.xxxx | (Obstetrics/Gynecology) | 240-276-0115 |
| 21 CFR 892.xxxx | (Radiology) | 240-276-0120 |
| Other | 240-276-0100 |
Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html
Sincerely yours,
Nancy C. Brogdon
Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
6
510(k) Number (if known):
Device Name: Fujinon Inc. G5 Gastroscopes
The device is intended for the visualization of the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb.
(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH Office of Device Evaluation (ODE)
ો Prescription Use (Per 21 CFR 801.109)
OR
Nancy C. Brogdon
(Division Sign-Off) Division of Reproductive, Abdominal, and Radiological Devic 510(k) Number.
Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________
(Optional Format 1-2-96)
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