K Number
K181418
Device Name
ScopeFlow Pure(TM)
Date Cleared
2019-07-11

(406 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The ScopeFlow Pure™ is intended to be used in in conjunction with a flexible endoscope to insufflate air/CO2 and supply sterile water during endoscopic procedures. The ScopeFlow Pure™ is compatible with the different sterile water bottles available. It is intended to be used for 24 hours and then disposed of.
Device Description
The ScopeFlow Pure™ is used to convey sterile water from an external water source to a flexible endoscope to aid its function. The ScopeFlow Pure™ consists of: 1) PVC tubing is used provide the method of transferring the sterile water from the external source to the flexible endoscope. This sterile water is used to clean the lens of the flexible endoscope during operation or to assist in improving the flexible endoscopes visual field. 2) An endoscope connector at the distal end of the device. For the ScopeFlow Pure™ the three different connectors are designed to fit Olympus, Pentax and Fujinon endoscopes. The connectors are manufactured from medical grade plastic, which is used as an outer housing and medical grade TPE or silicone which are used as seals to prevent water and air from escaping during use. The ScopeFlow Pure™ functions by using a two parallel tubes configuration to supply air to the water bottle and provide water to the flexible endoscope. The HYBRID configuration consists of the ScopeFlow Pure™ and an EndoStream™ units being used together. The HYBRID models function in the same way but instead of using a separate sterile bottle for irrigation of the lens and irrigation of the GI Tract, one bottle of sterile water is used as the feed for both, the Hybrid has only one screwcap.
More Information

Not Found

No
The device description focuses on mechanical components (tubing, connectors, screwcap) and fluid dynamics (supplying air and water). There is no mention of software, algorithms, image processing, or any terms related to AI/ML. The performance studies are related to sterilization, packaging, biocompatibility, and basic functionality, not algorithmic performance.

No
The device aids in endoscopic procedures by supplying air/CO2 and sterile water for cleaning and improving the visual field, but it does not directly treat a disease or condition. Its function is supportive to the main procedure.

No

The device description indicates that the ScopeFlow Pure™ is used to supply sterile water and insufflate air/CO2 during endoscopic procedures to aid the endoscope's function, primarily for cleaning the lens or improving the visual field. It does not mention any function related to diagnosing medical conditions.

No

The device description explicitly details physical components like PVC tubing, endoscope connectors made of medical-grade plastic and TPE/silicone, and a two parallel tubes configuration. It also mentions sterilization validation and biocompatibility testing, which are typical for physical medical devices. There is no mention of software as a component or function of the device.

Based on the provided information, the ScopeFlow Pure™ is not an In Vitro Diagnostic (IVD).

Here's why:

  • Intended Use: The intended use clearly states that the device is used in conjunction with a flexible endoscope to insufflate air/CO2 and supply sterile water during endoscopic procedures. This is a procedural aid, not a device used to examine specimens derived from the human body for the purpose of providing information for diagnosis, monitoring, or compatibility testing.
  • Device Description: The description details how the device physically conveys sterile water and air to the endoscope for cleaning the lens and improving the visual field. This is a mechanical function related to the endoscopic procedure itself.
  • Lack of IVD Characteristics: The description does not mention any analysis of biological samples, reagents, or any diagnostic purpose.

The device's function is to facilitate the endoscopic procedure by providing necessary fluids and gases, which falls outside the definition of an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The ScopeFlow Pure™ is intended to be used in in conjunction with a flexible endoscope to insufflate air/CO2 and supply sterile water during endoscopic procedures. The ScopeFlow Pure™ is compatible with the different sterile water bottles available. It is intended to be used for 24 hours and then disposed of.

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

OCX

Device Description

The ScopeFlow Pure™ is used to convey sterile water from an external water source to a flexible endoscope to aid its function.

The ScopeFlow Pure™ consists of:

  1. PVC tubing is used provide the method of transferring the sterile water from the external source to the flexible endoscope. This sterile water is used to clean the lens of the flexible endoscope during operation or to assist in improving the flexible endoscopes visual field.

  2. An endoscope connector at the distal end of the device. For the ScopeFlow Pure™ the three different connectors are designed to fit Olympus, Pentax and Fujinon endoscopes. The connectors are manufactured from medical grade plastic, which is used as an outer housing and medical grade TPE or silicone which are used as seals to prevent water and air from escaping during use.

The ScopeFlow Pure™ functions by using a two parallel tubes configuration to supply air to the water bottle and provide water to the flexible endoscope.

The HYBRID configuration consists of the ScopeFlow Pure™ and an EndoStream™ units being used together. The HYBRID models function in the same way but instead of using a separate sterile bottle for irrigation of the lens and irrigation of the GI Tract, one bottle of sterile water is used as the feed for both, the Hybrid has only one screwcap.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

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)

Performance testing was completed (per respective standards) for sterilization validation (ISO 11135), package and shelf-life testing and biocompatibility.

The ScopeFlow Pure™ product was evaluated for cytotoxicity, intracutaneous irritation and sensitization per biocompatibility requirements according to ISO 10993.

The ScopeFlow Pure™ products were also tested to demonstrate functionality and performance integrity.

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.

K140753, K971125

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

§ 876.1500 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

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July 11, 2019

Partnership Medical Limited Silbiano Gonzales Consultant QRC Consulting, LLC 10422 Huebner Road, Apt# 508 San Antonio, TX 78240

Re: K181418

Trade/Device Name: ScopeFlow Pure™ Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: OCX Dated: June 6, 2019 Received: June 10, 2019

Dear Silbiano Gonzales:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

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) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Shanil P. Haugen, Ph.D. Acting Assistant Division Director DHT3A: Division of Renal, Gastrointestinal, Obesity and Transplant Devices OHT3: Office of Gastrorenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K181418

Device Name ScopeFlow Pure™

Use (Describe)

The ScopeFlow Pure™ is designed to be used in conjunction with a flexible endoscope to insufflate air/CO2 and supply The Scoperiow Purem is designed to be used in voopeFlow Pure™ is compatible with the different sterile water bottles available. It is intended to be used for 24 hours and then disposed of

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)

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3

l. SUBMITTER

| Applicant Name:
Address: | Partnership Medical Limited
Hartley House, Galveston Grove
Fenton, Stoke on Trent, ST4 3PE |
|-----------------------------|--------------------------------------------------------------------------------------------------|
| Contact Person: | Rob Hartley, Director |
| US Contact / Correspondent: | QRC Consulting, LLC.
Silbiano Gonzales, Consultant |
| Address: | 5623 Hamilton Wolfe Rd.,
Apt# 921 San Antonio, TX
78240 |
| Phone:
Email: | (210) 287-9558
silbianog@sbcglobal.net |

DEVICE II.

Trade Name:
Catalog Number:

ScopeFlow Pure™

CATALOG (PART) NUMBERS
SFP145SFP145CO2SFP145CO2SSFP1451
HYBRIDSFP1452
HYBRID
SFP160SFP160CO2SFP160CO2SSFP1601
HYBRIDSFP1602
HYBRID
SFP165SFP165CO2SFP165CO2SSFP1651
HYBRIDSFP1652
HYBRID

Common or Usual Name: Regulation Name: Regulation Number: Device Class: Product Code:

Endoscopic Irrigation/Suction System Endoscope and accessories 21 CFR 876.1500 ll ОСХ

The Gastroenterology/Urology devices panel has classified Endoscopic Irrigation/Suction System as Class II under 21 CFR §870.1500. OCX is the product code that has been assigned for these types of devices.

PART 876 -- GASTROENTEROLOGY-UROLOGY-UROLOGY DEVICES

4

Subpart B--Diagnostic Devices

Sec. 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 mav 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 (performance standards).

(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.

Product Code: OCX

Device: Endoscopic irrigation/suction system

Definition: To supply sterile water, other solutions and/or suction to endoscopes during endoscopic procedures.

III. DEVICE DESCRIPTION

The ScopeFlow Pure™ is available in fifteen (15) configurations:

CATALOG (PART) NUMBERS
SFP145SFP145CO2SFP145CO2SSFP1451
HYBRIDSFP1452
HYBRID
SFP160SFP160CO2SFP160CO2SSFP1601
HYBRIDSFP1602
HYBRID
SFP165SFP165CO2SFP165CO2SSFP1651
HYBRIDSFP165
HYBRID

5

The ScopeFlow Pure™ is used to convey sterile water from an external water source to a flexible endoscope to aid its function.

The ScopeFlow Pure™ consists of:

  1. PVC tubing is used provide the method of transferring the sterile water from the external source to the flexible endoscope. This sterile water is used to clean the lens of the flexible endoscope during operation or to assist in improving the flexible endoscopes visual field.

  2. An endoscope connector at the distal end of the device. For the ScopeFlow Pure™ the three different connectors are designed to fit Olympus, Pentax and Fujinon endoscopes. The connectors are manufactured from medical grade plastic, which is used as an outer housing and medical grade TPE or silicone which are used as seals to prevent water and air from escaping during use.

The ScopeFlow Pure™ functions by using a two parallel tubes configuration to supply air to the water bottle and provide water to the flexible endoscope.

The HYBRID configuration consists of the ScopeFlow Pure™ and an EndoStream™ units being used together. The HYBRID models function in the same way but instead of using a separate sterile bottle for irrigation of the lens and irrigation of the GI Tract, one bottle of sterile water is used as the feed for both, the Hybrid has only one screwcap.

6

The ScopeFlow Pure™ is available in fifteen (15) configurations, according to endoscope manufacturer:

PFE/PML Product CodeEndoscope type
SFP145ScopeFlow Pure™ for Olympus 140 & 240 series endoscopes and higher
SFP145CO2ScopeFlow Pure™ for Olympus 140 & 240 series endoscopes and higher with CO2
SFP145CO2SScopeFlow Pure™ for Olympus 140 & 240 series endoscopes and higher with CO2 (short)
SFP1451 HYBRIDScopeFlow Pure™ for Olympus 140 & 240 series endoscopes and higher with CO2 and EndoStream™ PFE130
SFP1452 HYBRIDScopeFlow Pure™ for Olympus 140 & 240 series endoscopes and higher with CO2 and EndoStream™ PFE230
SFP160ScopeFlow Pure™ for Pentax endoscopes
SFP160CO2ScopeFlow Pure™ for Pentax endoscopes with CO2
SFP160CO2SScopeFlow Pure™ for Pentax endoscopes with CO2 (short)
SFP1601 HYBRIDScopeFlow Pure™ for Pentax endoscopes with CO2 (short) and EndoStream™ PFE130
SFP1602 HYBRIDScopeFlow Pure™ for Pentax endoscopes with CO2 (short) and EndoStream™ PFE230

| PFE/PML Product

CodeEndoscope type
SFP165ScopeFlow Pure™ for Fujinon endoscopes G5
and newer
SFP165CO2ScopeFlow Pure™ for Fujinon endoscopes G5
and newer with CO2
SFP165CO2SScopeFlow Pure™ for Fujinon endoscopes G5
and newer with CO2 (short)
SFP1651 HYBRIDScopeFlow Pure™ for Fujinon endoscopes
with CO2 & EndoStream™ PFE230
SFP1652 HYBRIDScopeFlow Pure™ for Fujinon endoscopes
with CO2 & EndoStream™ PFE130

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IV. INDICATIONS FOR USE

The ScopeFlow Pure™ is intended to be used in in conjunction with a flexible endoscope to insufflate air/CO2 and supply sterile water during endoscopic procedures. The ScopeFlow Pure™ is compatible with the different sterile water bottles available. It is intended to be used for 24 hours and then disposed of.

V. PREDICATE DEVICES

The ScopeFlow Pure™ is designed to be used with commercially available endoscopes and intended to be used in conjunction with a flexible endoscope to insufflate air and supply sterile water during endoscopic procedures. The ScopeFlow Pure™ is compatible with different commercially available sterile water bottles.

The ScopeFlow Pure™ legally marketed predicates, to which Partnership Medical Limited is claiming equivalence are:

Predicate Device for the ScopeFlow Pure™
CompanyPredicate Device NameFDA 510(k) Number
MedivatorsEndoSmart Bottle, Rinse and
Insufflation System [Model: 100145U /
100150U / 100160U / 100165CO2U /
100145CO2U / 100150CO2U /
100145CO2EXTU / 100150CO2EXTU /
100165CO2EXTU]K140753
Endo
SmartCap
CompanyThe Endo SmartCap [Model: 100145 /
100150]K971125

8

COMPARISON OF TECHNOLOGICAL CHARACTERISTICS VI. WITH THE PREDICATE DEVICES

The ScopeFlow Pure™ is substantially equivalent to both the Medivators (Endo Smart Bottle Rinse and Insufflation System, K140753) and the Endo SmartCap Company (Endo Smart Cap, K971125).

| Characteristic

ComparedOur DevicePredicate 1Predicate 2
ManufacturerPartnership
Medical, LtdEndo
SmartCap™
CompanyMedivators,
Inc.
DeviceScopeFlow
Pure™The Endo
SmartCap™Endo Smart
Bottle, Rinse
and Insufflation
System
510(k) Number-K971125K140753
IndicationThe ScopeFlow
Pure™ is intended
to be used in
conjunction with a
flexible endoscope
to insufflate
air/CO2 and supply
sterile water during
endoscopic
procedures.
The ScopeFlow
Pure™ is
compatible with the
different sterile
water bottles
available. It is
intended to be
used for 24
hours and then
disposed of.ENDO
SMARTCAP™
is intended to
supply sterile
water to series
10, 100 and
130 Olympus
endoscopes
when connected
to a commercially
available sterile
water bottle.EndoSmart
Bottle is
intended to be
used with an
air or CO2
source and/or
a pump along
with a sterile
water source to
supply air or
CO2 and
sterile water to
an endoscope
during
endoscopic
procedures.

9

| Characteristic

ComparedOur DevicePredicate 1Predicate 2
Product
Code/ClassOCXOCXOCX
Principle of
Operationused in
conjunction with
a flexible
endoscope to
insufflate air
and supply
sterile water
during
endoscopic
procedures.SimilarSimilar
DifferenceNo differenceNo differenceNo difference
Materials of
ConstructionPer section 16IdenticalIdentical
SterilizationEthylene
OxideEthylene OxideEthylene Oxide

VII. PERFORMANCE DATA

Performance testing was completed (per respective standards) for sterilization validation (ISO 11135), package and shelf-life testing and biocompatibility.

The ScopeFlow Pure™ product was evaluated for cytotoxicity, intracutaneous irritation and sensitization per biocompatibility requirements according to ISO 10993.

The ScopeFlow Pure™ products were also tested to demonstrate functionality and performance integrity.

VIII. CONCLUSIONS

Partnership Medical Limited considers the ScopeFlow Pure™ to be substantially equivalent to the legally marketed predicate device listed above, and safe and effective for the intended use. The conclusion is based on similarities in indications for use, materials, performance testing, technological characteristics, principle of operation and design features. Any differences do not raise any new issues of safety or effectiveness.