K Number
K191439
Device Name
OverStitch 2-0 Polypropylene Suture
Manufacturer
Date Cleared
2019-08-29

(91 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 does not mention any AI or ML components.

Yes
The device is described as an "Endoscopic Suturing System" intended for "endoscopic placement of suture(s) and approximation of soft tissue" within the gastrointestinal tract, which directly involves treating or correcting a medical condition.

No
The device is described as an endoscopic suturing system intended for placing sutures and approximating soft tissue, which are therapeutic actions, 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, this device 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 procedure performed on the patient's body, not a test performed on a sample taken from the body.
  • Device Description: The description details a system for suturing within the gastrointestinal tract using an endoscope. This is a medical device used for treatment or repair, not for diagnosing a condition by analyzing a sample.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on laboratory testing.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device's function is entirely procedural and therapeutic.

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 (comma separated list FDA assigned to the subject device)

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.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

within the gastrointestinal tract

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 included needle passing reliability, Suture Cinch deployment and pull-off strength, tensile strength per USP , needle pull off strength per USP and suture diameter measuremnts per USP .

Packaging Integrity was confirmed by repeating testing in accordance with ASTM F1929-15, ASTM DI69-16 and ASTM F1886/F1886M-16.

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

Biocompatibility assessments were performed in accordance with the appropriate risk category requirements, as defined in ISO 10933-1. Testing included extractable and leachable studies in accordance with ISO 10993-18: 2005 and a toxicological risk assessment in accordance with ISO 10993-17: 2002.

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.

K181141 - OverStitch™ Endoscopic Suturing System

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.

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August 29, 2019

Apollo Endosurgery David Hooper Director of Regulatory Affairs 1120 S. Capital of Texas Hwy Austin, Texas 78746

Re: K191439

Trade/Device Name: OverStitch Endoscopic Suturing System Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope And Accessories Regulatory Class: Class II Product Code: OCW Dated: May 29, 2019 Received: May 30, 2019

Dear David Hooper:

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

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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,

Dr. Nina Mezu-Nwaba Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K191439

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)
For testing Use in CFR 49, Subtitle B
For Training Use in CFR 49, Subtitle B

|× | Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary
Owner's Name & Address:Apollo Endosurgery
1120 S. Capital of Texas Hwy.
Building 1, Suite 300
Austin, TX 78746
Contact Person:David Hooper
Director, Regulatory Affairs
Phone: (512)-618-4855
Email : David.Hooper@apolloendo.com
Date:August 29, 2019
510(k) Number:K191439
Trade Name:OverStitch™ Endoscopic Suturing System
Common Name:Endoscopic Tissue Approximation Device
Product Code:OCW
Classification:Class II (21 CFR 876.1500)
Classification NameEndoscope and Accessories
Predicate Devices:K181141 - OverStitch™ Endoscopic Suturing System
Device DescriptionThe 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.

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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.

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

Modifications: The OverStitch Endoscopic Suturing System has been modified to add a new product code option for the OverStitch 2-0 Polypropylene Suture-Anchor Assembly. The remaining components of the system remain unchanged.

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Technological Characteristics:

| SUTURE-ANCHOR

ASSEMBLYOverStitch 2-0 Polypropylene Suture
Single UseYes
Shelf-Life Claim1-year
Materials-AnchorStainless Steel 316L Cobalt Chromium MP35
Materials-SutureUSP 2-0 Polypropylene Chemical Formula: -(CH(CH3)-CH2)n Copper Phthalocyanine Blue (Below 0.5 WT %) in accordance with
21CFR 74, 3045
DimensionsAnchor Suture Length: 6.6 mm 185 cm O.D.: 1.0 mm 2.0 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 to evaluate conformance to USP requirements, product specifications, and equivalence to the predicate design. The device was evaluated against individual functional and reliability requirements, as well as OverStitch Endoscopic Suturing System compatibility.

Performance Testing

Bench testing included needle passing reliability, Suture Cinch deployment and pull-off strength, tensile strength per USP , needle pull off strength per USP and suture diameter measuremnts per USP .

Packaging Integrity Packaging Integrity was confirmed by repeating testing in accordance with ASTM F1929-15, ASTM DI69-16 and ASTM F1886/F1886M-16.

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

Biocompatibility: Biocompatibility assessments were performed in accordance with the appropriate risk category requirements, as defined in ISO 10933-1. Testing included extractable and leachable studies in

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| | accordance with ISO 10993-18: 2005 and a toxicological risk
assessment in accordance with ISO 10993-17: 2002 |
|-----------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 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 their predicate device. |