K Number
K093236
Device Name
ETHICON ENDO-SURGERYOPTICAL DILATOR
Date Cleared
2009-11-10

(26 days)

Product Code
Regulation Number
876.5365
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Optical Dilator is indicated for dilation of strictures of the esophagus under endoscopic visualization.
Device Description
The Ethicon Endo-Surgery Optical Dilator is a sterile, single-use disposable esophageal dilator for use with an endoscope to dilate esophageal strictures under endoscopic visualization. The Optical Dilator is made from a clear flexible polymer. An endoscope having an outer diameter of 10mm or less, such as a standard gastroscope, is positioned within the Optical Dilator to allow for visualization at the stricture site.
More Information

Not Found

No
The device description and performance studies focus on the mechanical and material properties of a physical dilator, with no mention of software, algorithms, or data processing that would indicate AI/ML. The "Mentions AI, DNN, or ML" and "Mentions image processing" fields are explicitly marked as "Not Found".

Yes
The device is indicated for "dilation of strictures of the esophagus," which is a therapeutic intervention.

No
The device description and intended use state that the Optical Dilator is used for the dilation of strictures, which is a therapeutic action, not a diagnostic one.

No

The device description clearly states it is a sterile, single-use disposable esophageal dilator made from a clear flexible polymer, 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 Optical Dilator is a physical tool used inside the body (esophagus) to mechanically dilate strictures under direct visualization. It does not perform any tests on bodily samples.
  • Intended Use: The intended use is for "dilation of strictures of the esophagus," which is a therapeutic procedure, not a diagnostic test.

Therefore, the Optical Dilator is a therapeutic medical device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Optical Dilator is indicated for dilation of strictures of the esophagus under endoscopic visualization.

Product codes

KNQ

Device Description

The Ethicon Endo-Surgery Optical Dilator is a sterile, single-use disposable esophageal dilator for use with an endoscope to dilate esophageal strictures under endoscopic visualization. The Optical Dilator is made from a clear flexible polymer. An endoscope having an outer diameter of 10mm or less, such as a standard gastroscope, is positioned within the Optical Dilator to allow for visualization at the stricture site.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

esophagus

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)

Bench testing was completed to verify the attachment strength of the handle retainer/handle to the shaft. And, biocompatibility testing was conducted for the new handle and handle retainer materials in accordance with the requirements of ISO 10993-1 and FDA General Program Memorandum #G95-1: Use of International Standard ISO-10993, "Biological Evaluation of Medical Devices - Part 1: Evaluation and Testing." Test results demonstrate compliance with ISO 10993-1. A declaration of conformity with Design Controls is included in this submission as required for a Special 510(k). All criteria for success were met.

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

Not Found

Predicate Device(s)

K031147

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5365 Esophageal dilator.

(a)
Identification. An esophageal dilator is a device that consists of a cylindrical instrument that may be hollow and weighted with mercury or a metal olive-shaped weight that slides on a guide, such as a string or wire and is used to dilate a stricture of the esophagus. This generic type of device includes esophageal or gastrointestinal bougies and the esophageal dilator (metal olive).(b)
Classification. Class II (special controls). 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.

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093236
pg 1 of 2

510(k) Summary

CompanyEthicon Endo-Surgery, Inc.
4545 Creek Road
Cincinnati, OH 45242
  • Renee Rowe Contact Staff QS/RA Project Manager Ethicon Endo-Surgery, Inc. 4545 Creek Road Cincinnati, OH 45242 Telephone: (513) 337-8243 Fax: (513) 337-2243 Email: rrowe1@its.jnj.com
    Date Prepared: October 16, 2009

New Device Name

Trade Name: Ethicon Endo Surgery® Optical Dilator

Common or Usual Name: Esophageal Dilator

Classification Name: Esophageal Dilator

Predicate Devices

Ethicon Endo-Surgery Optical DVS (Dual Vector Shearing) Esophageal Dilator (K031147)

Device Description

The device description is the same as that for the predicate device. The Ethicon Endo-Surgery Optical Dilator is a sterile, single-use disposable esophageal dilator for use with an endoscope to dilate esophageal strictures under endoscopic visualization. The Optical Dilator is made from a clear flexible polymer. An endoscope having an outer diameter of 10mm or less, such as a standard gastroscope, is positioned within the Optical Dilator to allow for visualization at the stricture site.

Indications for Use

The intended use is the same as that for the predicate device. The Optical Dilator is indicated for dilation of strictures of the esophagus under endoscopic visualization.

Technological Characteristics

The Ethicon Endo-Surgery Optical Dilator has the same technological characteristics, design, and intended use as the predicate device. The only difference between the new device and the predicate device is that a handle retainer component has been added to secure the handle to the shaft, and the handle material was changed from gray to black. Risk analysis (Failure Mode and Effects and Hazard Analysis) and engineering analyses were used to assess the impact of the modifications.

NOV 1 0 2009

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093236
pg 2 of 2

Performance Data

Bench testing was completed to verify the attachment strength of the handle retainer/handle to the shaft. And, biocompatibility testing was conducted for the new handle and handle retainer materials in accordance with the requirements of ISO 10993-1 and FDA General Program Memorandum #G95-1: Use of International Standard ISO-10993, "Biological Evaluation of Medical Devices - Part 1: Evaluation and Testing." Test results demonstrate compliance with ISO 10993-1. A declaration of conformity with Design Controls is included in this submission as required for a Special 510(k). All criteria for success were met.

Risk analysis, engineering analysis, design verification of the attachment strength of the new handle retainer / handle to the shaft, and biocompatibility testing of the new materials indicate that neither the addition of the handle retainer nor the change in the handle material has an impact on the functionality of the device. The fundamental scientific technology and the intended use are the same.

EES believes the new devices are safe and effective and substantially equivalent to the predicate device.

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Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized eagle-like symbol with three curved lines representing wings or feathers.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room - WO66-G609 Silver Spring, MD 20993-0002

Ms. Renee Rowe Staff Project Manager, QS/RA Ethicon Endo-Surgery, Inc. a Johnson & Johnson Co. 4545 Creek Road CINCINNATI OH 45242

NOV 1 0 2009

Re: K093236

Trade/Device Name: Ethicon Endo Surgery® Optical Dilator Regulation Number: 21 CFR §876.5365 Regulation Name: Esophageal dilator Regulatory Class: II Product Code: KNQ Dated: October 14, 2009 Received: October 15, 2009

Dear Ms. Rowe:

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 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); medical device reporting (reporting of medical

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device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Janine M. Morris

Janine M. Morris Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): K093236

Ethicon Endo Surgery® Optical Dilator Device Name:

Indications for Use: The Optical Dilator is indicated for dilation of strictures of the esophagus under endoscopic visualization.

Prescription Use X (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)

Page 1 of 1 (Posted November 13, 2003)

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Division of Reproductive, Abdominal, and Radiological Devices 510(k) Number