K Number
K181141
Device Name
OverStitch Endoscopic Suturing System and Accessories
Manufacturer
Date Cleared
2018-06-27

(57 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The OverStitch Endoscopic Suturing System is intended for endoscopic placement of suture(s) and approximation of soft tissue.
Device Description
The OverStitch™ Endoscopic Suturing System and accessories are intended for endoscopic placement of sutures and approximation of soft tissue within the gastrointestinal tract utilizing either a dual channel or single-channel endoscope. The system is comprised of the Needle Driver Assembly and Anchor Exchange Device (collectively referred to as ESS), and accessories such as the Tissue Helix, Suture Cinch and Suture-Anchor Assembly devices. All devices are sterile packaged and designed for single use and are manufactured from various thermoplastic, silicone, stainless steel and other medical grade materials.
More Information

Not Found

No
The summary describes a mechanical endoscopic suturing system and its accessories, with no mention of AI or ML capabilities in the intended use, device description, or performance studies.

No.
The system is used for placement of sutures and approximation of soft tissue, which is a surgical tool function, not a therapeutic function.

No

The device description and intended use clearly state that the OverStitch Endoscopic Suturing System is for the "placement of suture(s) and approximation of soft tissue," which are therapeutic/surgical functions, not diagnostic ones.

No

The device description explicitly lists hardware components such as the Needle Driver Assembly, Anchor Exchange Device, Tissue Helix, Suture Cinch, and Suture-Anchor Assembly, made from various physical materials.

Based on the provided information, the OverStitch Endoscopic Suturing System is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for "endoscopic placement of suture(s) and approximation of soft tissue." This describes a surgical or procedural device used within the body to manipulate tissue.
  • Device Description: The description details a system of instruments used with an endoscope to place sutures. This aligns with a surgical/procedural device.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens (like blood, urine, tissue samples) outside the body to provide information about a patient's health, diagnosis, or condition. IVDs are typically used in laboratories or point-of-care settings for diagnostic purposes.

Therefore, the OverStitch Endoscopic Suturing System is a surgical/procedural device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The OverStitch Endoscopic Suturing System is intended for endoscopic placement of suture(s) and approximation of soft tissue.

Product codes

OCW

Device Description

The OverStitch™ Endoscopic Suturing System and accessories are intended for endoscopic placement of sutures and approximation of soft tissue within the gastrointestinal tract utilizing either a dual channel or single-channel endoscope. The system is comprised of the Needle Driver Assembly and Anchor Exchange Device (collectively referred to as ESS), and accessories such as the Tissue Helix, Suture Cinch and Suture-Anchor Assembly devices. All devices are sterile packaged and designed for single use and are manufactured from various thermoplastic, silicone, stainless steel and other medical grade materials.

OverStitch ESS
The OverStitch ESS is designed for compatibility with dual channel endoscopes. The endcap of the Needle Driver Assembly attaches to the distal end of the endoscope, and the handle attaches to the proximal end. The handle of the Needle Driver Assembly is squeezed to actuate the needle body and exchange the Suture-Anchor Assembly with the Anchor Exchange to perform stitching operations.

OverStitch Sx ESS
The OverStitch Sx ESS is designed for compatibility with single channel endoscopes. The ESS is mounted onto the endoscope using silicone straps distributed along the length of the catheter and endcap assembly. The external catheter sheath has two working channels through which the Anchor Exchange and OverStitch accessories can operate, independent of the endoscope channel. The handle of the Needle Driver Assembly is squeezed to actuate the needle body and exchange the proprietary Suture-Anchor Assembly with the Anchor Exchange to perform stitching operations.

OverStitch Tissue Helix
The OverStitch Helix is an optional device that is designed to acquire tissue by rotating the device handle into targeted area until tissue is gathered into the exposed helix coil. The acquired tissue is then pulled into proximity of the needle body to complete the stitching operation.

OverStitch Suture-Anchor Assembly
The OverStitch Suture-Anchor Assembly is comprised of a 510(k) cleared suture product, manufactured from either polydioxanone or polypropylene materials attached to an implantable anchor manufactured from cobalt chrome and stainless steel. The Anchor component is intended to function with the OverStitch ESS devices to perform stitching operations and serves as an anchor to secure suture placement.

OverStitch Suture Cinch
The Overstitch Suture Cinch device is comprised of thermoplastic and stainless steel materials and includes an implantable PEEK Cinch component designed to secure the placement of suture as a final step of an OverStitch procedure. The device functions by squeezing the handle and deploying the PEEK components that press-fit onto the tail end of the suture to maintain suture position in situ.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

gastrointestinal tract

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Prescription Use

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)

Non-Clinical Performance Data: Appropriate product testing was performed on all subject devices evaluate conformance to product specifications and to equivalence to the predicate designs. Verification and validation for the proposed system of devices was conducted in accordance with protocol. All devices were evaluated to their individual functional and reliability requirements, as well as system compatibility.

Performance Testing
Bench testing included needle passing reliability, needle pull off strength, Suture Cinch deployment and pull-off strength, Tissue Helix acquisition reliability and bond strength.

Packaging Integrity
Packaging Integrity was confirmed by repeating testing in accordance with ASTM F2096-11, ASTM DI69-16 and ASTM F88/F88M-15.

The results of all studies confirmed equivalency between the subject and predicate devices, and that no new issues of safety or efficacy were raised.

Biocompatibility: Biocompatibility testing and toxicological assessments were performed on subject OverStitch devices in accordance with their risk category requirements, as defined in ISO 10933-1. Testing included cytotoxicity and material mediated pyrogenicity.
Clinical Performance Data: Clinical testing was not required to demonstrate substantial equivalence.

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

Not Found

Predicate Device(s)

K171886

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.1500 Endoscope and accessories.

(a)
Identification. An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.(b)
Classification —(1)Class II (special controls). The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, 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 for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.

0

Image /page/0/Picture/0 description: The image shows the logo for the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health and Human Services seal on the left and the FDA acronym and name on the right. The FDA acronym and name are in blue, with the acronym in a square and the name in a sans-serif font. The logo is simple and professional, and it is easily recognizable.

June 27, 2018

Apollo Endosurgery % Ms. Maritza Ward Manager of Regulatory Affairs 1120 S. Capital of Texas Hwy Ste. 300 Austin, Texas 78746

Re: K181141

Trade/Device Name: OverStitch™ Endoscopic Suturing System and Accessories Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and Accessories Regulatory Class: Class II Product Code: OCW Dated: April 27, 2018 Received: May 1, 2018

Dear Ms. Ward:

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. 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 (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

1

K181141

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 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,

David Krause -S

for Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K181141

Device Name

Overstitch Endoscopic Suturing System

Indications for Use (Describe)

The OverStitch Endoscopic Suturing System is intended for endoscopic placement of suture(s) and approximation of soft tissue.

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)

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."

3

510(k) Summary

| Owner's Name & Address: | Apollo Endosurgery
1120 S. Capital of Texas Hwy.
Building 1, Suite 300
Austin, TX 78746 |
|-------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Maritza Ward
Manager, Regulatory Affairs
Phone: (512)-279-5114
Email: Maritza.Ward@apolloendo.com |
| Date: | June 22, 2018 |
| Trade Name: | OverStitch™ Endoscopic Suturing System |
| Common Name: | Endoscopic Tissue Approximation Device |
| Product Code: | OCW |
| Classification: | Class II (21 CFR 876.1500) |
| Classification Name | Endoscope and Accessories |
| Predicate Devices: | K171886 – OverStitch™ Endoscopic Suturing System |
| Device Description | The OverStitch™ Endoscopic Suturing System and accessories
are intended for endoscopic placement of sutures and
approximation of soft tissue within the gastrointestinal tract
utilizing either a dual channel or single-channel endoscope. The
system is comprised of the Needle Driver Assembly and Anchor
Exchange Device (collectively referred to as ESS), and
accessories such as the Tissue Helix, Suture Cinch and Suture-
Anchor Assembly devices. All devices are sterile packaged and
designed for single use and are manufactured from various
thermoplastic, silicone, stainless steel and other medical grade
materials. |
| | OverStitch ESS
The OverStitch ESS is designed for compatibility with dual
channel endoscopes. The endcap of the Needle Driver Assembly
attaches to the distal end of the endoscope, and the handle
attaches to the proximal end. The handle of the Needle Driver
Assembly is squeezed to actuate the needle body and exchange
the Suture-Anchor Assembly with the Anchor Exchange to
perform stitching operations. |

4

OverStitch Sx ESS

The OverStitch Sx ESS is designed for compatibility with single channel endoscopes. The ESS is mounted onto the endoscope using silicone straps distributed along the length of the catheter and endcap assembly. The external catheter sheath has two working channels through which the Anchor Exchange and OverStitch accessories can operate, independent of the endoscope channel. The handle of the Needle Driver Assembly is squeezed to actuate the needle body and exchange the proprietary Suture-Anchor Assembly with the Anchor Exchange to perform stitching operations.

OverStitch Tissue Helix

The OverStitch Helix is an optional device that is designed to acquire tissue by rotating the device handle into targeted area until tissue is gathered into the exposed helix coil. The acquired tissue is then pulled into proximity of the needle body to complete the stitching operation.

OverStitch Suture-Anchor Assembly

The OverStitch Suture-Anchor Assembly is comprised of a 510(k) cleared suture product, manufactured from either polydioxanone or polypropylene materials attached to an implantable anchor manufactured from cobalt chrome and stainless steel. The Anchor component is intended to function with the OverStitch ESS devices to perform stitching operations and serves as an anchor to secure suture placement.

OverStitch Suture Cinch

The Overstitch Suture Cinch device is comprised of thermoplastic and stainless steel materials and includes an implantable PEEK Cinch component designed to secure the placement of suture as a final step of an OverStitch procedure. The device functions by squeezing the handle and deploying the PEEK components that press-fit onto the tail end of the suture to maintain suture position in situ.

Indications for Use: The OverStitch Endoscopic Suturing System is intended for endoscopic placement of suture(s) and approximation of soft tissue.

5

Technological Characteristics:

NEEDLE DRIVER ASSEMBLYGen 2 Needle Driver AssemblySx Needle Driver Assembly
510(k) ClearanceK171886
Single UseYes
Shelf-Life Claim3-years1-year
General MaterialsStainless Steel ABSStainless Steel ABS Silicone
DimensionsLength: 130cm
O.D.: 2mm (distal end)Length: 117cm
O.D.: 2mm (distal end)
Suture MechanismThe handle of the Needle Driver Assembly is squeezed to actuate the needle body and exchange the proprietary suture assembly with the Anchor Exchange to perform stitching operations.
Compatible ScopesOlympus GIF-2TH180 GIF-2T160Single Channel Endoscopes that are 8.8 - 9.8 mm in diameter and up to 110cm in working length
Endcap + ScopePositionSeats on distal scope faceSide mount to distal end in any rotational orientation
AttachmentInterference fitTwo straps
SterilizationTerminally sterilized to SAL 10-6 using a validated EO method
ANCHOR EXCHANGEGen 2 Anchor Exchange
510(k) ClearanceK171886
Single UseYes
Shelf-Life Claim3-years (when packaged as ESS-G02-160)
1-year (when packaged as ESS-G02-Sx1)
General Materials• Stainless Steel
• ABS
DimensionsO.D.: 3.2mm (distal end)
Compatible ScopesDual Channel
Olympus
• GIF-2TH180
• GIF-2T160
Single Channel
Endoscopes that are 8.8 - 9.8mm in diameter and up to 110cm in working length
Method of ActuationButton on top of handle
Integrated With Needle
Driver AssemblyNo
SterilizationTerminally sterilized to SAL 10-6 using a validated EO method

6

SUTURE CINCHGen 2 Suture Cinch
510(k) ClearanceK171886
Single UseYes
Shelf-Life Claim3-years
MaterialsStainless Steel ABS VESTAKEEP PEEK
Cinch designPEEK Plug and collar components designed to press-fit together onto suture and hold construct in place.
DimensionsSuture Cinch Assembly:
Length: 152cm
O.D.: 2.4mm (distal end)

Deployed Cinch:
Length: 8mm
O.D. 2.4mm |
| User Sequence | Helix, Device Handle, Anchor Exchange, Cinch per DFU |
| Compatible Scopes | Dual Channel
Olympus GIF-2TH180 GIF-2T160 Single Channel
Endoscopes that are 8.8 - 9.8mm in diameter and up to 110cm in working length |
| Method of Actuation | Squeezing of Handle |
| Sterilization | Terminally sterilized to SAL $10^{-6}$ using a validated EO method |

TISSUE HELIXGen 2 Tissue Helix
510(k) ClearanceK171886
Single UseYes
Shelf-Life Claim3-years
MaterialsStainless Steel
Nitinol
PTFE
ABS
DimensionsLength: 165cm
O.D.: 2.4mm (distal end)
Compatible ScopesDual Channel
Olympus
GIF-2TH180
GIF-2T160
Single Channel
Endoscopes that are 8.8 - 9.8mm in diameter and up to 110cm in
working length
Outer Sheath
Protecting CoilYes
SterilizationTerminally sterilized to SAL 10-6 using a validated EO method

7

SUTURE-ANCHOR ASSEMBLYGen 2 Anchor
510(k) ClearanceK171886
Single UseYes
Shelf-Life Claim3-years
MaterialsStainless Steel 316LCobalt Chromium MP35
DimensionsAnchorSutureLength:6.6 mm185 cmO.D.:1.0 mm2.0 mmAnchorSutureLength:6.6 mm185 cmO.D.:1.0 mm2.0 mm
AnchorSuture
Length:6.6 mm185 cm
O.D.:1.0 mm2.0 mm
Suture Anchor DesignSuture-Anchor has a recessed feature on one end designed to engage with the Anchor Exchange, and a latch feature on the opposite end designed to engage with the Needle Body Assembly. The suture is swaged onto the center of the needle body to allow for the needle body to double as an anchor for the suture construct
SterilizationTerminally sterilized to SAL 10-6 using a validated EO method

Non-Clinical Performance Data: Appropriate product testing was performed on all subject devices evaluate conformance to product specifications and to equivalence to the predicate designs. Verification and validation for the proposed system of devices was conducted in accordance with protocol. All devices were evaluated to their individual functional and reliability requirements, as well as system compatibility.

Performance Testing

Bench testing included needle passing reliability, needle pull off strength, Suture Cinch deployment and pull-off strength, Tissue Helix acquisition reliability and bond strength.

Packaging Integrity

Packaging Integrity was confirmed by repeating testing in accordance with ASTM F2096-11, ASTM DI69-16 and ASTM F88/F88M-15.

The results of all studies confirmed equivalency between the subject and predicate devices, and that no new issues of safety or efficacy were raised.

  • Biocompatibility: Biocompatibility testing and toxicological assessments were performed on subject OverStitch devices in accordance with their risk category requirements, as defined in ISO 10933-1. Testing included cytotoxicity and material mediated pyrogenicity.
    Clinical Performance Data: Clinical testing was not required to demonstrate substantial equivalence.

  • Basis of Substantial Equivalence: Based on a comparison of indications for use and technological characteristics, the proposed devices have demonstrated substantial equivalence to the predicate device.