K Number
K173355
Device Name
Gastric Sizing Balloon Catheter
Manufacturer
Date Cleared
2017-11-17

(23 days)

Product Code
Regulation Number
876.5980
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Gastric Sizing Balloon Catheter is indicated for use in gastric surgical procedures to size the gastric pouch and drain and remove gastric fluid.
Device Description
The Gastric Sizing Balloon Catheter is an invasive device that consists of a 55 cm flexible gastric tube designed to be used during gastric and bariatric surgical procedures in a healthcare facility/hospital environment by a clinician. The 18 Fr catheter is inserted into the mouth, down the esophageal passage and advanced into the stomach temporarily. The Gastric Sizing Balloon Catheter is supplied with a 20 cc syringe, provided sterile in peel-open packaging, and intended for single-use only.
More Information

Not Found

No
The device description and performance studies focus on the physical characteristics and mechanical performance of a balloon catheter, with no mention of AI or ML.

No.
The device is used for sizing and fluid removal during surgical procedures, not for treating a disease or condition.

No

The device is used to size the gastric pouch and remove gastric fluid during surgical procedures, which is a functional role during a procedure rather than providing diagnostic information about a patient's condition.

No

The device description clearly states it is an "invasive device that consists of a 55 cm flexible gastric tube" and is supplied with a "20 cc syringe," indicating it is a physical hardware device, not software-only.

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

Here's why:

  • Intended Use: The intended use is for surgical procedures to size the gastric pouch and drain/remove gastric fluid. This is a direct intervention on the patient's body during surgery.
  • Device Description: The device is a catheter inserted into the body.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. This device does not perform such tests on samples.

The device is a surgical tool used in vivo (within the living body), not in vitro (in glass, or outside the body).

N/A

Intended Use / Indications for Use

The Gastric Sizing Balloon Catheter is indicated for use in gastric surgical procedures to size the gastric pouch and drain and remove gastric fluid.

Product codes

KNT

Device Description

The Gastric Sizing Balloon Catheter is an invasive device that consists of a 55 cm flexible gastric tube designed to be used during gastric and bariatric surgical procedures in a healthcare facility/hospital environment by a clinician. The 18 Fr catheter is inserted into the mouth, down the esophageal passage and advanced into the stomach temporarily. The Gastric Sizing Balloon Catheter is supplied with a 20 cc syringe, provided sterile in peel-open packaging, and intended for single-use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

gastric pouch

Indicated Patient Age Range

Not Found

Intended User / Care Setting

clinician, healthcare facility/hospital environment

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)

The subject device, Gastric Sizing Balloon Catheter, was subjected to applicable non-clinical testing to assure reliable design and performance under the testing parameters. The following non-clinical tests have been conducted to ensure reliable design and performance under the specified testing parameters.

  • Biocompatibility Testing - Testing was performed in accordance with BS EN ISO 10993-1:2003, the material and methods used to manufacture the subject device are nontoxic and met the acceptance criteria for their intended use.
  • Dimensional and Compatibility Analysis (Zero-time & Accelerated Aged) Dimensional . testing on the outer diameter and length of the balloon catheter was performed in accordance with the sponsor's acceptance criteria. The acceptance criteria were met.
  • Inflated Balloon Tensile (Zero-time & Accelerated Aged) Peak load of the balloon ■ portion was conducted in accordance with Annex B of BS EN 1618. The acceptance criteria were met.
  • Balloon Burst (Zero-time & Accelerated Aged) Balloon burst testing on the catheter . balloon was conducted in accordance with sponsor's acceptance criteria. The acceptance criteria were met.
  • Sideport Tensile (Zero-time & Accelerated Aged) – Uniaxial testing was conducted in accordance with Annex B of BS EN 1618. The acceptance criteria were met.
    In conclusion, the results of these non-clinical tests support a determination of substantial equivalence to the predicate device.

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

Not Found

Predicate Device(s)

K030841

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5980 Gastrointestinal tube and accessories.

(a)
Identification. A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use).(b)
Classification. (1) Class II (special controls). The barium enema retention catheter and tip with or without a bag that is a gastrointestinal tube and accessory or a gastronomy tube holder accessory is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I (general controls) for the dissolvable nasogastric feed tube guide for the nasogastric tube. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 876.9.

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November 17, 2017

Cook Incorporated Colin Jacob Regulatory Affairs Specialist 750 Daniels Way, P.O. Box 489 Bloomington, IN 47402

Re: K173355

Trade/Device Name: Gastric Sizing Balloon Catheter Regulation Number: 21 CFR§ 876.5980 Regulation Name: Gastrointestinal Tube and Accessories Regulatory Class: II Product Code: KNT Dated: October 24, 2017 Received: October 25, 2017

Dear Colin Jacob:

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. However, you are responsible to determine that the medical devices you use as components in the kit have either been determined as substantially equivalent under the premarket notification process (Section 510(k) of the act), or were legally on the market prior to May 28, 1976, the enactment date of the Medical Device Amendments. Please note: If you purchase your device components in bulk (i.e., unfinished) and further process (e.g., sterilize) you must submit a new 510(k) before including these components in your kit/tray. 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 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.

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.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

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

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Indications for Use

510(k) Number (if known) K173355

Device Name Gastric Sizing Balloon Catheter

Indications for Use (Describe)

The Gastric Sizing Balloon Catheter is indicated for use in gastric surgical procedures to size the gastric pouch and drain and remove gastric fluid.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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K173355 Page 1 of 3

COOK INCORPORATED 750 DANIELS WAY, P.O. BOX 489 BLOOMINGTON, IN 47402-0489 U.S.A. PHONE: 812.339.2235 TOLL FREE: 800.457.4500 WWW.COOKMEDICAL.COM

Image /page/3/Picture/2 description: The image shows the Cook Medical logo and the text "510(K) SUMMARY". The Cook Medical logo is a red square with the word "COOK" in white letters on the top line and the word "MEDICAL" in white letters on the bottom line. The text "510(K) SUMMARY" is in black letters and is located below the Cook Medical logo.

Submitted By:

Applicant: Contact: Applicant Address:

Contact Phone Number: Contact Fax Number:

Device Information:

Trade Name: Classification Name: Panel: Regulation: Product Code:

Gastric Sizing Balloon Catheter Gastrointestinal tube and accessories Gastroenterology/Urology 21 CFR § 876.5980 KNT

Cook Incorporated

Cook Incorporated P.O. Box 489 750 Daniels Way

(812) 332-0281

Bloomington, IN 47402

(812) 335-3575 x 104965

Colin Jacob

Predicate Devices:

  • 트 Cook Gastric Sizing Balloon Catheter (K030841)

Device Description:

The Gastric Sizing Balloon Catheter is an invasive device that consists of a 55 cm flexible gastric tube designed to be used during gastric and bariatric surgical procedures in a healthcare facility/hospital environment by a clinician. The 18 Fr catheter is inserted into the mouth, down the esophageal passage and advanced into the stomach temporarily. The Gastric Sizing Balloon Catheter is supplied with a 20 cc syringe, provided sterile in peel-open packaging, and intended for single-use only.

Indications for Use:

The Gastric Sizing Balloon Catheter is indicated for use in gastric and bariatric surgical procedures to size the gastric pouch and drain and remove gastric fluid.

Comparison to Predicates:

The Gastric Sizing Balloon Catheter and the predicate device, Gastric Sizing Balloon Catheter (K030841), are substantially equivalent in that these devices have the same intended use and

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Image /page/4/Picture/1 description: The image shows the logo for Cook Medical. The word "COOK" is in large, white, sans-serif font on a red background. Below the word "COOK" is the word "MEDICAL" in a smaller, white, sans-serif font on a darker red background.

COOK INCORPORATED 750 DANIELS WAY, P.O. BOX 489 BLOOMINGTON, IN 47402-0489 U.S.A. PHONE: 812.339.2235 TOLL FREE: 800.457.4500 WWW.COOKMEDICAL.COM

principles of operation, basic design, and functional characteristics. The only differences between the subject and predicate device are the materials as stated in the comparison table below.

Predicate DeviceSubject Device
Gastric Sizing Balloon CatheterGastric Sizing Balloon Catheter
(K030841)(subject of submission)
Regulation21 CFR § 876.5980IDENTICAL TO PREDICATE
Product CodeKNTIDENTICAL TO PREDICATE
ClassificationClass IIIDENTICAL TO PREDICATE
Indications for UseIndicated for use in gastric and
bariatric surgical procedures to size
the gastric pouch and drain and
remove gastric fluid.IDENTICAL TO PREDICATE
Intraoperative Use?YesIDENTICAL TO PREDICATE
Clinical ApplicationsGastric and bariatric surgical
proceduresIDENTICAL TO PREDICATE
Principle of OperationInserted into the esophageal passage
and advanced into the stomach
temporarily.IDENTICAL TO PREDICATE
Catheter Outer Diameter18 FrIDENTICAL TO PREDICATE
Catheter Length55 cmIDENTICAL TO PREDICATE
Markings Available?Yes (every 5 cm from 10 cm to 50
cm)IDENTICAL TO PREDICATE
Balloon Cuff Silicone
MaterialMED-4020MED-4720
Backfilled Tip Silicone
Adhesive MaterialMED-2000E951
Black Markings MaterialMED-4213GE615
Ferro Black PowderIDENTICAL TO PREDICATE
Additional AccessoriesMonoject luer-lock syringeIDENTICAL TO PREDICATE
Device for One-time Use?YesIDENTICAL TO PREDICATE
Provided Sterile?YesIDENTICAL TO PREDICATE
Sterilization ProcessEthylene OxideIDENTICAL TO PREDICATE
Sterility Assurance Level10-6IDENTICAL TO PREDICATE
PackagingPolyester-polyethylene/TyvekIDENTICAL TO PREDICATE
Shelf lifeTwo (2) yearsIDENTICAL TO PREDICATE

Technological Characteristics:

The subject device, Gastric Sizing Balloon Catheter, was subjected to applicable non-clinical testing to assure reliable design and performance under the testing parameters. The following non-clinical tests have been conducted to ensure reliable design and performance under the specified testing parameters.

  • Biocompatibility Testing - Testing was performed in accordance with BS EN ISO 10993-1:2003, the material and methods used to manufacture the subject device are nontoxic and met the acceptance criteria for their intended use.

5

Image /page/5/Picture/1 description: The image shows the logo for Cook Medical. The logo is set against a red background. The word "COOK" is written in white, block letters in the upper portion of the logo. Below the word "COOK" is the word "MEDICAL" in smaller, white letters, set against a darker red background.

COOK INCORPORATED 750 DANIELS WAY, P.O. BOX 489 BLOOMINGTON, IN 47402-0489 U.S.A. PHONE: 812.339.2235 TOLL FREE: 800.457.4500 WWW.COOKMEDICAL.COM

  • Dimensional and Compatibility Analysis (Zero-time & Accelerated Aged) Dimensional . testing on the outer diameter and length of the balloon catheter was performed in accordance with the sponsor's acceptance criteria. The acceptance criteria were met.
  • Inflated Balloon Tensile (Zero-time & Accelerated Aged) Peak load of the balloon ■ portion was conducted in accordance with Annex B of BS EN 1618. The acceptance criteria were met.
  • Balloon Burst (Zero-time & Accelerated Aged) Balloon burst testing on the catheter . balloon was conducted in accordance with sponsor's acceptance criteria. The acceptance criteria were met.
  • Sideport Tensile (Zero-time & Accelerated Aged) – Uniaxial testing was conducted in accordance with Annex B of BS EN 1618. The acceptance criteria were met.

In conclusion, the results of these non-clinical tests support a determination of substantial equivalence to the predicate device.