K Number
K051950
Device Name
INSCOPE MULTI-CLIP APPLIER, MODELS IN22321, IN23321
Date Cleared
2005-10-07

(81 days)

Product Code
Regulation Number
876.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The InScope Multi-Clip Applier is indicated for use with an endoscope to place clips in the gastrointestinal (GI) tract for the purpose of: - Endoscopic marking, . - Hemostasis for: ● - o Mucosal and submucosal defects < 3 cm - Bleeding ulcers o - o Arteries < 2 mm - o Polyps < 1.5 cm in diameter - o Diverticula in the colon - Anchoring to affix jejunal feeding tubes to the wall of the small bowel, . - Closure of GI tract luminal perforations < 20 mm in patients where an alternative . to surgery is required.
Device Description
The InScope™ Mult-Clip Applier is a sterile, single patient use, disposable instrument capable of attaching clips to the mucosal lining of the gastrointestinal (GI) tract. The clips are used to create hemostasis and/or tissue approximation. The distal, flexible portion of the applier is designed to work with a flexible endoscope having a minimum working channel diameter of 3.2 mm. Two opposing jaws grasp tissue via a manually activated lever on a proximal handle. Once the closure lever is latched, a firing mechanism is manually activated, which deploys a titanium clip over the target tissue. The device is supplied preloaded with four (4) titanium clips.
More Information

Not Found

No
The device description and performance studies focus on mechanical clip application and tissue approximation, with no mention of AI or ML technologies.

Yes
The device is used to place clips in the GI tract for purposes such as hemostasis (stopping bleeding), anchoring, and closure of perforations, which are all therapeutic interventions.

No

The device is described as an "InScope Multi-Clip Applier" used to place clips in the GI tract for purposes such as endoscopic marking, hemostasis, anchoring feeding tubes, and closure of perforations. These are interventional or therapeutic actions, not diagnostic ones.

No

The device description clearly states it is a sterile, single patient use, disposable instrument with physical components like a flexible portion, jaws, a handle, and a firing mechanism that deploys titanium clips. This indicates it is a hardware device, not software-only.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health. This testing is done outside of the body (in vitro).
  • Device Function: The InScope Multi-Clip Applier is a surgical instrument used inside the body (in vivo) during an endoscopic procedure. It directly interacts with and modifies tissue within the gastrointestinal tract.
  • Intended Use: The intended uses listed (endoscopic marking, hemostasis, anchoring feeding tubes, closure of perforations) are all therapeutic or procedural actions performed directly on the patient's internal tissues. They do not involve testing samples taken from the body.

Therefore, the InScope Multi-Clip Applier falls under the category of a surgical or therapeutic device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The InScope Multi-Clip Applier is indicated for use with an endoscope to place clips in the gastrointestinal (GI) tract for the purpose of:

  • Endoscopic marking, .
  • Hemostasis for: ●
    • o Mucosal and submucosal defects

§ 876.4400 Hemorrhoidal ligator.

(a)
Identification. A hemorrhoidal ligator is a device used to cut off the blood flow to hemorrhoidal tissue by means of a ligature or band placed around the hemorrhoid.(b)
Classification. Class II (special controls). Except for a hemostatic metal clip intended for use in the gastrointestinal tract, the device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

K051950

OCT 7 - 2005

InScope™ Multi-Clip Applier 510(k) Summary of Safety and Effectiveness

Company

INSCOPE A Division of Ethicon Endo-Surgery, Inc. 4545 Creek Rd. Cincinnati, OH 45242

Contact

Kimberly Shoemaker, RAC Manager, Regulatory Affairs

Date Prepared:

July 15, 2005

Name of Device

Trade Name: InScope™ Multi-Clip Applier Classification Name: Clip Applier/Endoscopic Clipping Device

Predicate Devices:

Trade Name: Syntheon, LLC: Endoscopic Multi-Fire Clip Applier Olympus Optical Co., Ltd .: Rotatable Clip Fixing Device HX-5/6-1

Device Description

The InScope™ Mult-Clip Applier is a sterile, single patient use, disposable instrument capable of attaching clips to the mucosal lining of the gastrointestinal (GI) tract. The clips are used to create hemostasis and/or tissue approximation. The distal, flexible portion of the applier is designed to work with a flexible endoscope having a minimum working channel diameter of 3.2 mm. Two opposing jaws grasp tissue via a manually activated lever on a proximal handle. Once the closure lever is latched, a firing mechanism is manually activated, which deploys a titanium clip over the target tissue. The device is supplied preloaded with four (4) titanium clips.

1

K051950

pg 2 of 2

Indications for Use

The InScope Multi-Clip Applier is indicated for use with an endoscope to place clips in the gastrointestinal (GI) tract for the purpose of:

  • Endoscopic marking, .
  • Hemostasis for: ●
    • o Mucosal and submucosal defects