K Number
K152607
Device Name
Express SD Biliary Monorail Premounted Stent System
Manufacturer
Date Cleared
2015-10-27

(46 days)

Product Code
Regulation Number
876.5010
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Express SD Biliary Monorail Premounted Stent System is indicated for palliation of malignant neoplasms in the biliary tree.
Device Description
Not Found
More Information

Not Found

No
The 510(k) summary describes a stent system, a mechanical device, and makes no mention of AI, ML, image processing, or any other technology typically associated with AI/ML. The performance studies focus on bench testing for magnetic resonance compatibility, not algorithmic performance.

Yes
The device is indicated for "palliation of malignant neoplasms in the biliary tree," which describes a therapeutic purpose to alleviate symptoms or slow the progression of a disease.

No

Explanation: The device is indicated for "palliation of malignant neoplasms in the biliary tree," which means it is used for treatment or symptom relief, not for diagnosis.

No

The device is described as a "Stent System," which is a physical implantable device. The performance studies mention "Bench testing" and "Magnetic Resonance compatibility," which are typical evaluations for hardware devices, not software.

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

Here's why:

  • Intended Use: The intended use is "palliation of malignant neoplasms in the biliary tree." This describes a therapeutic intervention performed within the body, not a test performed on samples taken from the body.
  • Device Description: While the description is "Not Found," the name "Stent System" strongly suggests a device implanted or used within the body.
  • Lack of IVD Indicators: There is no mention of analyzing samples (blood, urine, tissue, etc.), performing tests in vitro (outside the body), or providing diagnostic information based on laboratory analysis.

IVDs are devices used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device's function is to physically open a blocked passage in the biliary tree, which is a therapeutic action, not a diagnostic one.

N/A

Intended Use / Indications for Use

The Express SD Biliary Monorail Premounted Stent System is indicated for palliation of malignant neoplasms in the biliary tree.

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

FGE

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

biliary tree

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 performed to support a determination of Magnetic Resonance compatibility. The results of these tests provide reasonable assurance that the proposed device has been designed and tested to assure conformance to the requirements for its intended use. No new safety or performance issues were raised during the device testing.

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.

K040027

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

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 stylized image of three human profiles facing right, stacked on top of each other. The profiles are depicted in a single, continuous line. The logo is surrounded by a circular border containing the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in capital letters.

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

October 27, 2015

Boston Scientific Corporation Anna Deraney Regulatory Affairs Specialist One Scimed Place Maple Grove, MN 55311

Re: K152607

Trade/Device Name: Express® SD Biliary Monorail® Premounted Stent System Regulation Number: 21 CFR§ 876.5010 Regulation Name: Biliary catheter and accessories Regulatory Class: II Product Code: FGE Dated: September 10, 2015 Received: September 11, 2015

Dear Anna Deraney,

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.

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.

1

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

| DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration
Indications for Use
Form Approved: OMB No. 0910-0120
Expiration Date: January 31, 2017
See PRA Statement below.
510(k) Number (if known)K152607
Device NameExpress® SD Biliary Monorail® Premounted Stent System
Indications for Use (Describe)The Express SD Biliary Monorail Premounted Stent System is indicated for palliation of malignant neoplasms in the biliary tree.
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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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."

FORM FDA 3881 (8/14)Page 1 of 1
-----------------------------------

PSC Publishing Services (301) 443-6740 EF

CENSEANS SECOUNDERS US TAGESTAN PORTAL P

געוואלא אויפטעמענען אונגענען געגענען געבוירעט

TANSEERS SERVER SERVER PRODUCT AND AND A SECURITIES A SECURITER POLICE A PARA PARA A PARA A PARA A PARA A PA

NATURE FACTORING WATERSED AND POSTED AND POSTED AND POSTED AND PARTER FEE

ristinester

конковкомиссия продушу представляется по представляется предправления предправления представленным представленным продоженным продоженным продоженным продорожниками сельности

3

510k Summary

Per 21 CFR §807.92

| Common or Usual

NameBiliary Stent and Balloon Dilatation Catheter
Trade Name(s)Boston Scientific Express® SD Biliary Monorail® Premounted Stent
System
Product CodeFGE - Catheter, Biliary, Diagnostic
Classification of
DeviceBoston Scientific Corporation Express SD Biliary catheters and
accessories have been classified as Class II devices according to 21
CFR 876.5010
Submitter's Name
and AddressBoston Scientific Corporation
One Scimed Place
Maple Grove, MN 55311-1566
Contact Name and
InformationAnna Deraney
Regulatory Affairs Specialist
Phone: 763-494-1683
Fax: 763-494-2222
Email: anna.deraney@bsci.com
Section 514 of the
Act Performance
StandardsCurrently no FDA mandated or voluntary performance standards exist
for this device.
Establishment
Registration
NumbersOwner /Operator:
Boston Scientific Corporation
300 Boston Scientific Way
Marlborough, MA 01752
ERN: 9912058
Manufacturing
Facility:
Boston Scientific Corporation
Two Scimed Place
Maple Grove, MN 55311
ERN: 2134265
Sterilization
Facilities:
Synergy Health Ireland Limited
IDA Business & Technology Park
Tullamore, County Offaly, Ireland
BSC Coventry
8 Industrial Drive
Coventry, RI 02816, USA
Predicate DevicesExpress® SD Biliary Monorail® Premounted Stent System cleared
March 30, 2004
Intended Use/
Indications for UseThe Express SD Biliary Monorail Premounted Stent System is
indicated for palliation of malignant neoplasms in the biliary tree.
Comparison of
Required
Technological
CharacteristicsThe proposed Express SD Biliary device is substantially equivalent to
the existing Express SD Biliary device cleared by FDA under
premarket notification K040027 (March 30, 2004). Express SD has
the same intended use, scientific technology, design, materials,
sterilization method, and packaging materials (with the exception of
the accessory kit) as the applicable predicate device.
The labeling (carton labels, pouch labels, and Directions for Use) are
being updated to include language and test data to support the
Magnetic Resonance Environment conditions under which the
Express SD Biliary device is compatible.
Summary of Non-
Clinical Test
SummaryBench testing was performed to support a determination of Magnetic
Resonance compatibility. The results of these tests provide
reasonable assurance that the proposed device has been designed
and tested to assure conformance to the requirements for its intended
use. No new safety or performance issues were raised during the
device testing.
ConclusionBased on the indications for use, technological characteristics, and
safety and performance testing, the proposed Express SD Biliary
Premounted Stent System has been shown to be appropriate for its
intended use and is considered to be substantially equivalent to the
Express SD Biliary Monorail Premounted Stent System (K040027).

4