K Number
K050502
Device Name
SINGLE USE BALLOON DILATOR MAXPASSTM
Date Cleared
2005-07-08

(130 days)

Product Code
Regulation Number
876.5010
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Single use balloon dilator Maxpass ™ to be used in conjunction with Olympus endoscopes for dilating strictures of the biliary tree and the major papilla during endoscopic applications.
Device Description
Single use balloon dilator Maxpass ™ is a triple lumen catheter with a balloon Single use banoon and of the catheter. Balloon dilators are used to exert radial force to dilate narrow duct segments, as well as the Sphincter of Oddi.
More Information

Not Found

No
The summary describes a mechanical balloon dilator and makes no mention of AI or ML.

Yes
The device is used for dilating strictures of the biliary tree and the major papilla, which is a therapeutic intervention aimed at treating a medical condition.

No
The device, a balloon dilator, is used to exert radial force to dilate narrow ducts and the Sphincter of Oddi. Its function is to treat a condition by physically expanding a passage, not to diagnose a condition.

No

The device description clearly states it is a "triple lumen catheter with a balloon," indicating it is a physical medical device, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. These tests are performed outside of the body.
  • Device Function: The description clearly states the device is a "balloon dilator" used "in conjunction with Olympus endoscopes for dilating strictures of the biliary tree and the major papilla during endoscopic applications." This is a device used within the body to physically manipulate tissue.
  • Lack of IVD Characteristics: The description does not mention any testing of samples, analysis of biological markers, or any other activity typically associated with IVD devices.

Therefore, the Maxpass™ balloon dilator is a therapeutic device used for a procedure performed inside the body, not an IVD.

N/A

Intended Use / Indications for Use

Single use balloon dilator Maxpass ™ to be used in conjunction with Olympus endoscopes for dilating strictures of the biliary tree and the major papilla during endoscopic applications.

Product codes (comma separated list FDA assigned to the subject device)

FGE

Device Description

Single use balloon dilator Maxpass ™ is a triple lumen catheter with a balloon Single use banoon and of the catheter. Balloon dilators are used to exert radial force to dilate narrow duct segments, as well as the Sphincter of Oddi.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

biliary tree and the major papilla

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K001338, K920361

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 876.5010 Biliary catheter and accessories.

(a)
Identification. A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic type of device may include a bile collecting bag that is attached to the biliary catheter by a connector and fastened to the patient with a strap.(b)
Classification. Class II (special controls). The device, when it is a bile collecting bag or a surgical biliary catheter that does not include a balloon component, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

SMDA 510(k) SUMMARY

A. Submitter's Name, Address, Phone and Fax Numbers

Applicant:Olympus Winter & Ibe, GmbH
Address:Kuehnstr. 61
Hamburg 22045, Germany
Establishment Registration No.:8010313
Submission Correspondent:OLYMPUS AMERICA Inc.
Address:Two Corporate Center Drive,
Melville, NY 11747-9058
B. Name of Contact Person
Contact:Laura Storms-Tyler
Title:Director Regulatory Affairs
Telephone:631-844-5688
Facsimile:631-844-5554

Initial Importer: Address:

Establishment Registration No.:

Establishment Registration No.:

। ।

2429304

OLYMPUS AMERICA Inc. Two Corporate Center Drive,
Melville, NY 11747-9058 2429304

C. Device Name, Common Name, Classification Name and Predicate Devices

Trade Name:Single use balloon dilator MaxPassTM
Common Name:Balloon dilation catheter
Classification:Biliary catheter and accessories
21 CFR 876.5010
Predicate Device:Microvasive Rapid ExchangeTM Biliary Balloon
Dilation Catheter
(K001338 Boston Scientific Corporation)
Bard biliary Balloon Dilators
(K920361 C.R.Bard, Inc.)

1

D. Description of the Device(s)

Single use balloon dilator Maxpass ™ is a triple lumen catheter with a balloon Single use banoon and of the catheter. Balloon dilators are used to exert radial force to dilate narrow duct segments, as well as the Sphincter of Oddi.

E. Intended Use of the Device(s)

Single use balloon dilator Maxpass ™ to be used in conjunction with Olympus endoscopes for dilating strictures of the biliary tree and the major papilla during endoscopic applications.

F. Summary including Conclusions drawn from Non-clinical Tests

When compared to the predicate device, the Single use balloon dilator Maxpass TM
an and the predicate in the same in Which compared to the p significant changes in the intended use, method of operation, material, or design that could affect safety or effectiveness.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/2 description: The image shows a black and white drawing of a bird in flight. The bird is facing to the right and has three lines running through its body. There is some text in a circular pattern to the left of the bird. The text is not clear enough to read.

JUL - 8 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Laura Storms-Tyler Executive Director Regulatory Affairs & Quality Assurance Olympus America, Inc. Two Corporate Center Drive MELVILLE NY 11747-3157

Re: K050502

K050302
Trade/Device Name: Single use balloon dilator MaxPass™ Regulation Number: 21 CFR §876.5010 Regulation Name: Biliary catheter and accessories Regulatory Class: II Product Code: FGE Dated: July 5, 2005 Received: July 6, 2005

Dear Ms. Storms-Tyler:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced We have reviewed your booked by equivalent (for the indications for use stated in above and nave occommod the ad predicate devices marketed in interstate commerce prior to the enclosure) to tegary maneloce presented Device Antendments, or to devices that have been May 20, 1 770, the chaounce with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that reclassified in accordation war are novel application (PMA). You may, therefore, market the do not require approval of a premation of the Act. The general controls provisions of the Act device, subject to the general controls provises, 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 n your device is classifica (see abore) into stirols. Existing major regulations affecting your Approval), It 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 Please be advised that I DA s issualled of a successions of the requirements of the Act of any FDA has made a decemination mail four control and receives. You must comply with all the Federal statues and regulations administed to registration and listing (21 CFR Part 807); labeling Act s requirements, including, but hot million is regultements as set forth in the quality systems (QS) (21 CFR Part 801); and 801); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

This letter will allow you to begin marketing your device as described in your Section 5 10(k)
1 a legally This letter will allow you to begin marketing your antial equivalence of your device to a legally premarket notification. The FDA Inding of substantial equive 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 If you desire specific advice for your device on our laboring regarmed 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
Other240-276-0100

Also, please note the regulation entitled, "Misbranding by reference to prematiket notification" (21 CFR Also, please note the regulation entitled, "virsonalians" of our responsibilities under the Act from the 807.97). You may obtain other gelleral mionnation on your copied on its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours, -

Nancy C. Hogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known): None Koso 50 Z Device Name: Single use balloon dilator MaxPass™

Indications For Use: Single use balloon dilator Maxpass ™ to be used in conjunction with Olympus endoscopes for dilating strictures of the biliary tree and the major papilla during endoscopic applications.

Prescription Use
(Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Nancy C. Brogdon

(Division Sign-Off) ive. Abdomina Division of Reproduct and Radiological Device 510(k) Number.

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