K Number
K181905
Device Name
AXIOS Stent and Delivery System, AXIOS Stent and Electrocautery Enhanced Delivery System
Date Cleared
2019-03-25

(252 days)

Product Code
Regulation Number
876.5015
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The AXIOS Stent and Delivery System & AXIOS Stent and Electrocautery Enhanced Delivery System are indicated for use to facilitate transgastric or transduodenal endoscopic drainage of symptomatic pancreatic pseudocysts ≥6cm in size, and symptomatic Walled Off Necrosis ≥6cm in size, with ≥70% fluid content, that are adherent to the gastric or bowel wall. Once placed, the AXIOS stent functions as an access port allowing passage of standard and therapeutic endoscopes to facilitate debridement, irrigation and cystoscopy. The stent is intended for implantation up to 60 days and should be removed upon confirmation of pseudocyst or Walled Off Necrosis resolution.
Device Description
The AXIOS Stent is a flexible, MR conditional, fully-covered self-expanding braided nitinol stent, which comes preloaded into the delivery system. The AXIOS stent is designed with two flanges on each end to prevent migration and to enable tissue plane apposition and a "saddle" in between the flanges to span the tissue implant distance. Non-Cautery Enhanced Delivery System: The stent is preloaded within the AXIOS delivery catheter. The Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS stent. The Delivery System is designed to be used in the gastrointestinal tract in conjunction with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially-available 0.035-inch insulated endoscopic guidewires. Electrocautery Enhanced Delivery System: The AXIOS Electrocautery Enhanced Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS Sten. The AXIOS Electrocautery Enhanced Delivery System is designed to be used in the gastrointestinal tract with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially available 0.035-inch insulated endoscopic guidewires. The Electrocautery Enhanced Delivery System connects with an off-the-shelf electrosurgical unit or generator that is compliant to IEC 60601-1-2 and IEC 60601-2-2. The AXIOS Stent and Electrocautery Enhanced Delivery System is provided sterile, disposable and intended for single use.
More Information

No
The description focuses on the mechanical and material properties of the stent and delivery system, with no mention of AI or ML capabilities. The performance studies are bench testing and biocompatibility, not related to algorithmic performance.

Yes

The device aids in the drainage of pancreatic pseudocysts and walled-off necrosis, and serves as an access port for debridement, irrigation, and cystoscopy, which are all therapeutic interventions aimed at resolving a medical condition.

No

This device is a stent and delivery system used for drainage and access in pancreatic pseudocysts and Walled Off Necrosis. It is a therapeutic device, not a diagnostic one.

No

The device description clearly details hardware components including a stent, delivery system catheter, integrated handle with manual controls, and connections for an electrosurgical unit.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The AXIOS Stent and Delivery System is a medical device designed for surgical intervention (facilitating drainage and access) within the body. It is implanted and used to treat a condition (pancreatic pseudocysts and walled-off necrosis).
  • Lack of Specimen Analysis: The description does not mention the device being used to analyze any biological specimens in vitro (outside the body). Its function is entirely in vivo (within the body).

The device is a therapeutic and access device used during an endoscopic procedure, not a diagnostic tool that analyzes samples.

N/A

Intended Use / Indications for Use

The AXIOS Stent and Delivery System & AXIOS Stent and Electrocautery Enhanced Delivery System are indicated for use to facilitate transgastric or transduodenal endoscopic drainage of symptomatic pancreatic pseudocysts ≥6cm in size, and symptomatic Walled Off Necrosis ≥6cm in size, with ≥70% fluid content, that are adherent to the gastric or bowel wall. Once placed, the AXIOS stent functions as an access port allowing passage of standard and therapeutic endoscopes to facilitate debridement, irrigation and cystoscopy. The stent is intended for implantation up to 60 days and should be removed upon confirmation of pseudocyst or Walled Off Necrosis resolution.

Product codes

PCU, KNS

Device Description

The AXIOS Stent is a flexible, MR conditional, fully-covered self-expanding braided nitinol stent, which comes preloaded into the delivery system. The AXIOS stent is designed with two flanges on each end to prevent migration and to enable tissue plane apposition and a "saddle" in between the flanges to span the tissue implant distance.

Non-Cautery Enhanced Delivery System:

The stent is preloaded within the AXIOS delivery catheter. The Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS stent. The Delivery System is designed to be used in the gastrointestinal tract in conjunction with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially-available 0.035-inch insulated endoscopic guidewires.

Electrocautery Enhanced Delivery System:

The AXIOS Electrocautery Enhanced Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS Sten. The AXIOS Electrocautery Enhanced Delivery System is designed to be used in the gastrointestinal tract with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially available 0.035-inch insulated endoscopic guidewires.

The Electrocautery Enhanced Delivery System connects with an off-the-shelf electrosurgical unit or generator that is compliant to IEC 60601-1-2 and IEC 60601-2-2.

The AXIOS Stent and Electrocautery Enhanced Delivery System is provided sterile, disposable and intended for single use.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Pancreatic (pseudocysts, Walled Off Necrosis), gastric or bowel wall.

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: The proposed passivated AXIOS Stent successfully passed all pre-defined product specifications and is equivalent to the predicate passivated AXIOS stent for the tests performed. There are no changes to the delivery system or the stent dimensions for the current AXIOS stents.

TestResults (Pass/ Fail)
1Deployed Stent Saddle LengthPass
2Deployed Stent Saddle Outer DiameterPass
3Deployed Stent Flange WidthPass
4Corrosion Testing via ASTM Standard F2129 Standard Test Method for Conducting Cyclic Potentiodynamic Polarization Measurements to Determine the Corrosion Susceptibility of Small Implant DevicesPass
5Stent FatiguePass
6Stent Radial Strength –in expansion & in compressionPass
7Stent Deployment ForcePass

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

Not Found

Predicate Device(s)

K153088, K163272

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5015 Pancreatic drainage stent and delivery system.

(a)
Identification. A pancreatic drainage stent is a prescription device that consists of a self-expanding, covered, metallic stent, intended for placement to facilitate transmural endoscopic drainage of pancreatic pseudocysts. This stent is intended to be removed upon confirmation of pseudocyst resolution. This device may also include a delivery system.(b)
Classification. Class II (special controls). The special controls for this device are:(1) The device and elements of the delivery device that may contact the patient must be demonstrated to be biocompatible.
(2) Performance data must demonstrate the sterility of patient-contacting components of the device.
(3) Performance data must support the shelf life of the device by demonstrating continued sterility, package integrity, and device functionality over the requested shelf life.
(4) Non-clinical testing data must demonstrate that the stent and delivery system perform as intended under anticipated conditions of use. The following performance characteristics must be tested:
(i) Deployment testing of the stent and delivery system must be conducted under simulated use conditions.
(ii) Removal force testing must be conducted. The removal force testing must demonstrate that the stent can be safely removed, and that the stent will remain in place when subjected to forces encountered during use.
(iii) Expansion force testing must be conducted. The expansion force must demonstrate that the forces exerted by the stent will not damage the tissue surrounding the stent.
(iv) Compression force testing must be conducted. The compression force must demonstrate that the stent will withstand the forces encountered during use.
(v) Dimensional verification testing must be conducted.
(vi) Tensile testing of joints and materials must be conducted. The minimum acceptance criteria must be adequate for its intended use.
(vii) Fatigue testing must be conducted. Material strength must demonstrate that the stent will withstand forces encountered during use.
(viii) Corrosion testing must be conducted. Corrosion resistance must demonstrate that the stent will withstand conditions encountered during use.
(5) Non-clinical testing must evaluate the compatibility of the stent in a magnetic resonance (MR) environment.
(6) Well-documented clinical experience must demonstrate safe and effective use, and capture any adverse events observed during clinical use.
(7) Labeling must include the following:
(i) Appropriate instructions, warnings, cautions, limitations, and information related to the safe use of the device, including deployment of the device, maintenance of the drainage lumen, and removal of the device.
(ii) A warning that the safety and patency of the stent has not been established beyond the duration of the documented clinical experience.
(iii) Specific instructions and the qualifications and clinical training needed for the safe use of the device, including deployment of the device, maintenance of the drainage lumen, and removal of the device.
(iv) Information on the patient population for which the device has been demonstrated to be effective.
(v) A detailed summary of the clinical experience pertinent to use of the device.
(vi) A detailed summary of the device technical parameters.
(vii) A detailed summary of the device- and procedure-related complications pertinent to use of the device.
(viii) An expiration date/shelf life.

0

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March 25, 2019

Boston Scientific Corporation Kayla Mackey Senior Regulatory Affairs Specialist 100 Boston Scientific Way Marlborough, MA 01752

Re: K181905

Trade/Device Name: AXIOS Stent and Delivery System, AXIOS Stent and Electrocautery Enhanced Delivery System Regulation Number: 21 CFR& 876.5015 Regulation Name: Pancreatic Drainage Stent and Delivery System Regulatory Class: II Product Code: PCU, KNS Dated: February 25, 2019 Received: February 26, 2019

Dear Kayla Mackey:

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.

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 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/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (QS) 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 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,

Mark J. Antonino -S

for

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 UseForm Approved: OMB No. 0910-0120
Expiration Date: 06/30/2020
See PRA Statement below.
510(k) Number ( if known )
Unknown K181905
Device Name
AXIOS Stent and Delivery System
AXIOS Stent and Electrocautery Enhanced Delivery System
Indications for Use (Describe)
The AXIOS Stent and Delivery System & AXIOS Stent and Electrocautery Enhanced Delivery System are indicated for use to facilitate transgastric or transduodenal endoscopic drainage of symptomatic pancreatic pseudocysts ≥6cm in size, and symptomatic Walled Off Necrosis ≥6cm in size, with ≥70% fluid content, that are adherent to the gastric or bowel wall. Once placed, the AXIOS stent functions as an access port allowing passage of standard and therapeutic endoscopes to facilitate debridement, irrigation and cystoscopy. The stent is intended for implantation up to 60 days and should be removed upon confirmation of pseudocyst or Walled Off Necrosis resolution.
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.

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and review the collection of information. Send comments regarding this burden estimate or any other aspect
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FORM FDA 3881 (7/17)Page 1 of 1
-----------------------------------

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SECTION 5. 510(K) SUMMARY

510(k) SUMMARY

1. Submitter:

Boston Scientific Corporation 100 Boston Scientific Way Marlborough, MA 01752

Kayla Mackey Regulatory Affairs Specialist Telephone: 508-683-4534 Fax: 508-683-5939

Date Prepared: July 13, 2018

2. Device:

Trade Name:

Device Common Name: Classification Name:

Regulation Number:

Product Code:

Classification:

AXIOS™ Stent and Electrocautery-Enhanced Delivery System Pancreatic drainage stent and delivery system & endoscopic electrosurgical unit and accessories Pancreatic drainage stent and delivery system and endoscopic electrosurgical unit and accessories 21CFR 876.5015 21CFR 876.4300 PCU/ KNS Class II

Trade Name: AXIOSTM Stent and Delivery System Device Common Name: Pancreatic drainage stent and delivery system Classification Name: Pancreatic drainage stent and delivery system Regulation Number: 21CFR 876.5015 Product Code: PCU Classification: Class II

4

    1. Predicate Device

| Trade Name: | AXIOST™ Stent and Electrocautery-Enhanced
Delivery System & AXIOSTM Stent |
|----------------------|---------------------------------------------------------------------------------------------------------|
| 510(k) Number: | K153088/ K163272 |
| Device Common Name: | Pancreatic drainage stent and delivery system &
endoscopic electrosurgical unit and accessories |
| Classification Name: | Pancreatic drainage stent and delivery system
and endoscopic electrosurgical unit and
accessories |
| Regulation Number: | 21CFR 876.5015
21CFR 876.4300 |
| Product Code: | PCU/ KNS |
| Classification: | Class II |
| Trade Name: | AXIOSTM Stent and Delivery System |
| 510(k) Number: | K153088 |
| Device Common Name: | Pancreatic drainage stent and delivery system |
| Classification Name: | Pancreatic drainage stent and delivery system |
| Regulation Number: | 21CFR 876.5015 |
| Product Code: | PCU |

4. Device Description

AXIOS Stent:

The AXIOS Stent is a flexible, MR conditional, fully-covered self-expanding braided nitinol stent, which comes preloaded into the delivery system. The AXIOS stent is designed with two flanges on each end to prevent migration and to enable tissue plane apposition and a "saddle" in between the flanges to span the tissue implant distance.

Non-Cautery Enhanced Delivery System:

The stent is preloaded within the AXIOS delivery catheter. The Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS stent. The Delivery System is designed to be used in the gastrointestinal tract in conjunction with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially-available 0.035-inch insulated endoscopic guidewires.

Electrocautery Enhanced Delivery System:

The AXIOS Electrocautery Enhanced Delivery System consists of a catheter and an integrated handle with manual controls for positioning and deploying the AXIOS Sten. The AXIOS Electrocautery Enhanced Delivery System is designed to be used in the gastrointestinal tract with

5

commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially available 0.035-inch insulated endoscopic guidewires.

The Electrocautery Enhanced Delivery System connects with an off-the-shelf electrosurgical unit or generator that is compliant to IEC 60601-1-2 and IEC 60601-2-2.

The AXIOS Stent and Electrocautery Enhanced Delivery System is provided sterile, disposable and intended for single use. Table 5-1 below discusses the main features of the AXIOS Stent and Electrocautery Enhanced Delivery System.

Component/DesignFeature Description
Catheter• Provided sterile, for single-patient use
• Working length:
138 cm Electrocautery Enhanced
Delivery System
139 cm Non-cautery Delivery
System
• Outer Diameter 10.8 Fr
• Fluoroscopy: AXIOS Stent is contained
between two (2) Platinum Iridium
Markers
Handle• Staged delivery system for precise stent
placement
⇒Two (2)-step release of each flange,
including a full "stop"
⇒Lock-out after the release of the first
flange, preventing unintended
deployment of the second flange
Guidewire Compatibility
Endoscope Compatibility0.035" insulated guidewires
• Compatible with 3.7 mm diameter or
larger working channel
• Delivery system is luer-locked to the
proximal end of the biopsy port of the
endoscope
AXIOS Stent Design• Bi-flange or double anchor for Staged and
Precise positioning
• Flange/anchor designed to:
⇒hold tissue layers in apposition
⇒prevent migration
• MR Conditional
• Provided sterile, for single-patient use
AXIOS Stent Lumen• Large stent lumen diameter and short flow
path/conduit to
⇒Facilitate passive efficient drainage
⇒Facilitate passage of endoscopic
tools for assessment and treatment
AXIOS Stent MaterialNitinol (Nickel-Titanium) ⇒Shape memory and superelasticity for controlled placement and optimal deployment ⇒Corrosion resistant and biocompatible
AXIOS Stent CoveringFully covered with Silicone ⇒Well tolerated by surrounding tissue to minimize tissue ingrowth ⇒Provides leak protection and minimizes tissue ingrowth allowing for atraumatic stent removal
AXIOS Stent VisualizationThe Stent is delivered constrained within a delivery system and deployed under visualization ⇒EUS confirmation of first flange deployment ⇒Direct endoscopic or EUS viewing of second flange deployment ⇒Radiopacity of Nitinol allows fluoroscopy of deployed stent

Table 5-1: AXIOS Stent and Delivery System- Main Features

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5. Indications for Use:

The AXIOS Stent is indicated for use to facilitate transgastric or transduodenal endoscopic drainage of symptomatic pancreatic pseudocysts ≥6cm in size, and symptomatic Walled Off Necrosis ≥6cm in size, with ≥70% fluid content, that are adherent to the gastric or bowel wall. Once placed. the AXIOS stent functions as an access port allowing passage of standard and therapeutic endoscopes to facilitate debridement, irrigation and cystoscopy. The stent is intended for implantation up to 60 days and should be removed upon confirmation of pseudocyst or Walled Off Necrosis resolution.

6. Technological Characteristics

The proposed AXIOS Stent is equivalent to the predicate AXIOS stent. A manufacturing change was made to remove the passivation/etching manufacturing step. This change was documented internally. The purpose of this 510(k) is to reinstate this manufacturing step. There are no changes to the delivery system for either the electrocautery-enhanced version or the non-electrocautery enhanced version. The stent dimensions and materials, intended use, delivery system, and mode of operation remains identical to the predicate AXIOS Stent and Electrocautery Enhanced Delivery system and AXIOS Stent and Delivery System cleared via K153088 & K163272.

7. Performance Data

Bench Testing:

7

The proposed passivated AXIOS Stent successfully passed all pre-defined product specifications and is equivalent to the predicate passivated AXIOS stent for the tests performed. There are no changes to the delivery system or the stent dimensions for the current AXIOS stents. Below is a summary of the tests performed to show the proposed device satisfied all design verification and validation requirements.

TestResults (Pass/ Fail)
1Deployed Stent Saddle LengthPass
2Deployed Stent Saddle Outer DiameterPass
3Deployed Stent Flange WidthPass
4Corrosion Testing via ASTM Standard F2129 Standard
Test Method for Conducting Cyclic Potentiodynamic
Polarization Measurements to Determine the Corrosion
Susceptibility of Small Implant DevicesPass
5Stent FatiguePass
6Stent Radial Strength –in expansion & in compressionPass
7Stent Deployment ForcePass

8. Biocompatibility Testing:

The proposed AXIOS Stent is equivalent to the predicate AXIOS stent. A manufacturing change was made to remove the passivation/etching manufacturing step. This change was documented internally. The purpose of this 510(k) is to reinstate this manufacturing step. There are no changes to the delivery system for either the electrocautery-enhanced version of the non-electrocautery enhanced version. The predicate biocompatibility testing conducted per EN ISO 10993-1 continues to be representative of the proposed AXIOS stent and delivery systems. Boston Scientific did conduct a Cytotoxicity test on the finished stent as a screening test to ensure the manufacturing change did not impact the toxicity of the device.

Conclusion

The purpose of this 510(k) is to reinstate the passivation/etching manufacturing step for the AXIOS stents. The manufacturing change to the passivation/etching step has been reinstated and remains identical to the predicate AXIOS device cleared via K153088 and K163272. The information Boston Scientific Corporation provided in this submission demonstrates that the proposed AXIOS Stent is substantially equivalent to the currently cleared AXIOS Stents cleared via K153088 & K163272.