K Number
K051972
Device Name
KARL STORZ TRANS-NASAL ESOPHAGOSCOPE
Date Cleared
2005-08-15

(25 days)

Product Code
Regulation Number
874.4710
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Karl Storz Trans-Nasal Esophagoscopes are designed to be used by qualified surgeons and physicians and are indicated for endoscopic access and examination of the nasal sinuses, larynx, esophagus and gastro-esophageal junction and, using additional accessories, to perform various diagnostic and therapeutic procedures.
Device Description
The Karl Storz Trans-Nasal Esophagoscopes are manually operated surgical devices, flexible fiberoptic telescopes that utilize fiber-optic technology. The body contact portions of the Kall Storz Trans-Nasal Esophagoscopes are manufactured using medical grade polyurethane.
More Information

Not Found

No
The summary describes a manually operated, fiber-optic endoscope and does not mention any AI or ML capabilities.

Yes
The "Intended Use / Indications for Use" explicitly mentions performing diagnostic and therapeutic procedures using additional accessories.

Yes
The device is indicated for "examination" of anatomical sites and to perform "various diagnostic and therapeutic procedures," which includes diagnostic functions.

No

The device description explicitly states it is a "manually operated surgical device, flexible fiberoptic telescopes" and mentions the use of "medical grade polyurethane" for body contact portions, indicating it is a physical hardware device.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is for "endoscopic access and examination of the nasal sinuses, larynx, esophagus and gastro-esophageal junction" and for "diagnostic and therapeutic procedures" using accessories. This describes a device used directly on the patient for visualization and intervention.
  • Device Description: The description confirms it's a "manually operated surgical device, flexible fiberoptic telescope." This is a physical instrument used for internal examination.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health. The provided information does not mention any analysis of biological samples.

Therefore, the Karl Storz Trans-Nasal Esophagoscopes are medical devices used for direct patient examination and procedures, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

The Karl Storz Trans-Nasal Esophagoscopes are designed to be used by qualified surgeons and physicians and are indicated for endoscopic access and examination of the nasal sinuses, larynx, esophagus and gastro-esophageal junction and, using additional accessories, to perform various diagnostic and therapeutic procedures.

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

EOX

Device Description

The Karl Storz Trans-Nasal Esophagoscopes are manually operated surgical devices, flexible fiberoptic telescopes that utilize fiber-optic technology. The body contact portions of the Kall Storz Trans-Nasal Esophagoscopes are manufactured using medical grade polyurethane.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

nasal sinuses, larynx, esophagus and gastro-esophageal junction

Indicated Patient Age Range

Not Found

Intended User / Care Setting

qualified surgeons and physicians

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.

K981458, K031786

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

§ 874.4710 Esophagoscope (flexible or rigid) and accessories.

(a)
Identification. An esophagoscope (flexible or rigid) and accessories is a tubular endoscopic device with any of a group of accessory devices which attach to the esophagoscope and is intended to examine or treat esophageal malfunction symptoms, esophageal or mediastinal disease, or to remove foreign bodies from the esophagus. When inserted, the device extends from the area of the hypopharynx to the stomach. It is typically used with a fiberoptic light source and carrier to provide illumination. The device is made of materials such as stainless steel or flexible plastic. This generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier.(b)
Classification. Class II.

0

K051972

AUG 15 2005

Karl Storz Endoscopy-America, Inc.

600 Corporate Pointe 5th Floor Culver City, California 90230-7600 Phone 310 338 8100

Toll Free 800 421 0837 Fax 310 410 5527

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of the Safe Medical Devices Act (SMDA) of 1990 and 21 CFR 807.92. All data included in this document is accurate and complete to the best of KSEA's knowledge.

| Applicant: | Karl Storz Endoscopy - America, Inc.
600 Corporate Pointe Drive
Culver City, CA 90230
(310) 410-2769 |
|------------------------|---------------------------------------------------------------------------------------------------------------|
| Contact: | Yvonne Fernandez
Senior Regulatory Affairs Specialist |
| Device Identification: | Common Name - Flexible Esophagoscopes |

Trade Name - Karl Storz Trans-Nasal Esophagoscopes (11301BN1, 11302BD1)

Indication: The Karl Storz Trans-Nasal Esophagoscopes are designed to be used by qualified surgeons and physicians and are indicated for endoscopic access and examination of the nasal sinuses, larynx, esophagus and gastro-esophageal junction and, using additional accessories, to perform various diagnostic and therapeutic procedures.

Device Description: The Karl Storz Trans-Nasal Esophagoscopes are manually operated surgical devices, flexible fiberoptic telescopes that utilize fiber-optic technology. The body contact portions of the Kall Storz Trans-Nasal Esophagoscopes are manufactured using medical grade polyurethane.

Substantial Equivalence: The Karl Storz Trans-Nasal Esophagoscopes are substantially equivalent to the predicate devices since than haudi ESOphagoscopes are substantialiy are the same. The minor differences between the Karl Storz and interined does Esophagoscopes and the KSEA Rhino-Laryngo-Broncho-Fiberscope and Broncho-Fiberscope and Broncho-Fiberscope (K981458), and the TNE-2000 marketed by Vision Sciences, Inc. (K031786) raise no new issues of safety and effectiveness, as these design differences have no affect on the performance, function or intended use of the devices.

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Image /page/1/Picture/2 description: The image is a black and white logo for the Department of Health & Human Services - USA. The logo is circular in shape, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter of the circle. In the center of the circle is a stylized symbol that resembles a person with their arms outstretched.

AUG 1 5 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Karl Storz Endoscopy-America, Inc. c/o Yvonne Fernandez Senior Regulatory Affairs Specialist 600 Corporate Pointe, 5th Floor Culver City, CA 90230-7600

Re: K051972

Trade/Device Name: Trans-Nasal Esophagoscope Regulation Number: 21 CFR 874.4710 Regulation Name: Esophagoscopes and accessories Regulatory Class: Class II Product Code: EOX Dated: July 20, 2005 Received: July 21, 2005

Dear Ms. Fernandez:

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 (PMA), 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.

2

Page 2 - Yvonne Fernandez

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 (301) 827-8910. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 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/industry/support/index.html.

Sincerely yours,

David M. Whipple

Acting Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

510(k) Number (if known): Not yet assigned

Device Name: Karl Storz Trans-Nasal Esophagoscopes

Indications for Use:

The Karl Storz Trans-Nasal Esophagoscopes are designed to be used by qualified surgeons and physicians and are indicated for endoscopic access and examination of the nasal sinuses, larynx, esophagus and gastro-esophageal junction and, using additional accessories, to perform various diagnostic and therapeutic procedures.

(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) ______________________________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)

Kassitkova

Division of Ophthalmic Ear. Nose and Throat Devises

510(k) Number K051972