K Number
K142680
Device Name
ENDOCAPSULE SOFTWARE 10; ENDOCAPSULE SOFTWARE 10 LIGHT
Date Cleared
2015-02-08

(142 days)

Product Code
Regulation Number
876.1300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is intended for visualization of the small intestine mucosa. The Red Color Detection Function is intended to mark frames of the video suspected of containing blood or red areas.
Device Description
OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is a capsule imaging system used for visualization of the small intestine mucosa. This system consists of a capsule endoscope which captures images and transmits the data, an antenna unit and a recorder which are secured around the patient and receive data from the capsule, workstation software which downloads the image data from the recorder and processes images for visualization. The new workstation software, MAJ-2188 ENDOCAPSULE SOFTWARE 10 and MAJ-2189 ENDOCAPSULE SOFTWARE 10 LIGHT, are the subjects of this submission.
More Information

Not Found

No
The document mentions image processing but does not explicitly mention AI, ML, or related terms like deep learning (DNN). The description of the "Red Color Detection Function" suggests a rule-based or algorithmic approach rather than an AI/ML model trained on data. There is no mention of training or test data sets, which are typically associated with AI/ML development.

No.
The device is described as an "imaging system used for visualization" and its intended use is "for visualization of the small intestine mucosa." It processes images for visualization and detects red areas, but it does not treat or cure any condition.

Yes
The device is intended for visualization of the small intestine mucosa, which is a diagnostic activity. Additionally, the Red Color Detection Function is intended to mark frames suspected of containing blood or red areas, aiding in the identification of abnormalities, which is a diagnostic function.

No

The device description explicitly states the system consists of a capsule endoscope, antenna unit, and recorder, in addition to the workstation software. While the submission focuses on the software, the overall system includes hardware components.

Based on the provided information, the OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is not an In Vitro Diagnostic (IVD).

Here's why:

  • IVDs are used to examine specimens from the human body. The description clearly states that this system is used for "visualization of the small intestine mucosa" within the patient. It's an in-vivo imaging system, not a device that analyzes samples taken from the body.
  • The intended use is for visualization. While it processes images, the primary purpose is to allow a healthcare professional to visually examine the small intestine.
  • There is no mention of analyzing biological samples. The system captures images, not blood, tissue, or other bodily fluids.

Therefore, this device falls under the category of an in-vivo imaging system rather than an IVD.

N/A

Intended Use / Indications for Use

The OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is intended for visualization of the small intestine mucosa. The Red Color Detection Function is intended to mark frames of the video suspected of containing blood or red areas.

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

NEZ

Device Description

OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is a capsule imaging system used for visualization of the small intestine mucosa. This system consists of a capsule endoscope which captures images and transmits the data, an antenna unit and a recorder which are secured around the patient and receive data from the capsule, workstation software which downloads the image data from the recorder and processes images for visualization.

The new workstation software, MAJ-2188 ENDOCAPSULE SOFTWARE 10 and MAJ-2189 ENDOCAPSULE SOFTWARE 10 LIGHT, are the subjects of this submission.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

small intestine mucosa

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 were performed to support technical changes.
Risk analysis was carried out in accordance with established in-house acceptance criteria based on ISO 14971:2007. The design verification tests and their acceptance criteria were identified and performed as a result of this risk analysis assessment.
The software validation activities were performed in accordance with the FDA Guidance, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices." The device software is considered a Moderate Level of Concern.

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.

K123421

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

§ 876.1300 Ingestible telemetric gastrointestinal capsule imaging system.

(a)
Identification. An ingestible telemetric gastrointestinal capsule imaging system is used for visualization of the small bowel mucosa as an adjunctive tool in the detection of abnormalities of the small bowel. The device captures images of the small bowel with a wireless camera contained in a capsule. This device includes an ingestible capsule (containing a light source, camera, transmitter, and battery), an antenna array, a receiving/recording unit, a data storage device, computer software to process the images, and accessories.(b)
Classification. Class II (special controls). The special control is FDA's guidance, “Class II Special Controls Guidance Document: Ingestible Telemetric Gastrointestinal Capsule Imaging Systems; Final Guidance for Industry and FDA.”

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, stacked on top of each other.

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

February 8, 2015

OLYMPUS MEDICAL SYSTEMS CORP. % Daphney Germain-Kolawole Regulatory Affairs Project Manager Olympus Corporation of the Americas 3500 Corporate Parkway, PO Box 610 Center Valley, PA 18034-0610

Re: K142680

Trade/Device Name: OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM Regulation Number: 21 CFR§ 876.1300 Regulation Name: Ingestible telemetric gastrointestinal capsule imaging system Regulatory Class: II Product Code: NEZ Dated (Date on orig SE ltr): November 17, 2014 Received (Date on orig SE ltr): November 18, 2014

Dear Daphnev Germain-Kolawole.

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

1

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 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 contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Benjamin R. Fisher -S

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

510(k) Number (if known)

K142680

Device Name

OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM

Indications for Use (Describe)

The OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is intended for visualization of the small intestine mucosa. The Red Color Detection Function is intended to mark frames of the video suspected of containing blood or red areas.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW .

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

510(k) SUMMARY OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM

September 18, 2014

-General Information

  • OLYMPUS MEDICAL SYSTEMS CORP. Applicant: 2951 Ishikawa-cho, Hachioji-shi, Tokyo, Japan 192-8507 Establishment Registration No: 8010047
  • Official Daphney Germain-Kolawole Correspondent: Regulatory Affairs Project Manager Olympus Corporation of the Americas 3500 Corporate Parkway PO Box 610 Center Valley, PA 18034-0610, USA Phone: 484-896-5691 FAX: 484-896-7128 Email: daphney.germain-kolawole@olympus.com
  • Manufacturer: OLYMPUS MEDICAL SYSTEMS CORP. HINODE PLANT 34-3 Hirai, Hinode-machi, Nishitama-Gun, Tokyo, 190-0182, Japan Establishment Registration Number: 3003637092

.. Device Identification

  • Device Trade Name: OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM
  • Common Name: Capsule Imaging System
  • Regulation Number: 876.1300
  • Regulation Name: Ingestible telemetric gastrointestinal capsule imaging system
  • Regulatory Class: II (Special Controls)
  • Classification Panel: Gastroenterology and urology
  • Product Code: NEZ

4

Predicate Device Information

Model nameApplicant510(k) No.
OLYMPUS CAPSULE ENDOSCOPE
SYSTEMOLYMPUS MEDICAL
SYSTEMS CORP.K123421

IV. Device Description

OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is a capsule imaging system used for visualization of the small intestine mucosa. This system consists of a capsule endoscope which captures images and transmits the data, an antenna unit and a recorder which are secured around the patient and receive data from the capsule, workstation software which downloads the image data from the recorder and processes images for visualization.

The new workstation software, MAJ-2188 ENDOCAPSULE SOFTWARE 10 and MAJ-2189 ENDOCAPSULE SOFTWARE 10 LIGHT, are the subjects of this submission.

V. Indications for Use

The OLYMPUS SMALL INTESTINAL CAPSULE ENDOSCOPE SYSTEM is intended for visualization of the small intestine mucosa. The Red Color Detection Function is intended to mark frames of the video suspected of containing blood or red areas.

VI. Comparison of Technological Characteristics

Compared to the legally marketed, predicate devices, the subject workstation software is reconstructed to improve operability. Technological characteristics of the subject device are identical or similar to the predicate device. A detailed comparison of the subject devices with the predicate devices is provided in the premarket notification.

5

VII. Summary of non-clinical testing

  • · Bench testing were performed to support technical changes.

  • · Risk analysis was carried out in accordance with established in-house acceptance criteria based on ISO 14971:2007. The design verification tests and their acceptance criteria were identified and performed as a result of this risk analysis assessment.

  • · The software validation activities were performed in accordance with the FDA Guidance, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices." The device software is considered a Moderate Level of Concern.

  • · The following standards have been applied to the subject devices:

  • ISO 14971

VIII. Conclusion

When compared to the predicate device, the MAJ-2188 and the MAJ-2189 do not incorporate any significant changes in intended use, method of operation, or design that could affect the safety or effectiveness of the device.