K Number
K230439
Device Name
WellCare Anoscope
Date Cleared
2023-12-22

(304 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
WellCare Anoscope is intended for transanal use to provide physicians access to the anal sphincter, anus, and rectum and to perform various diagnostic and therapeutic procedures using additional accessories.
Device Description
WellCare Anoscope is composed of Anoscope, Introducer and Sleeve.The anoscopes are divided into the following models according to the way the components are configured and the differences in size : WellCare-ANO-Light Sterile . WellCare-ANO-Truncated Sterile.This is a single use, disposable device(s), provided sterile.
More Information

Not Found

No
The 510(k) summary describes a simple, disposable anoscope with no mention of AI, ML, image processing, or any software-driven analytical capabilities. The performance studies are limited to bench testing of physical and chemical properties.

Yes
The intended use explicitly mentions performing "therapeutic procedures."

Yes
Explanation: The "Intended Use / Indications for Use" section explicitly states that the device is intended for physicians to "perform various diagnostic and therapeutic procedures." This indicates its use in the diagnostic process.

No

The device description explicitly states it is composed of physical components (Anoscope, Introducer, and Sleeve) and is a single-use, disposable hardware device. There is no mention of software as the primary or sole component.

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

Here's why:

  • Intended Use: The intended use is for providing access to anatomical structures (anal sphincter, anus, and rectum) and performing diagnostic and therapeutic procedures. This involves direct interaction with the patient's body, not the examination of samples taken from the body.
  • Device Description: The device is a physical instrument (anoscope, introducer, sleeve) used for visualization and access. It does not involve reagents, calibrators, or other components typically associated with in vitro testing.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or performing tests outside of the body.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The WellCare Anoscope is a medical device used for direct examination and procedures within the body.

N/A

Intended Use / Indications for Use

WellCare Anoscope is intended for transanal use to provide physicians access to the anal sphincter, anus, and rectum and to perform various diagnostic and therapeutic procedures using additional accessories.

Product codes

FER

Device Description

WellCare Anoscope are intended for the examination of the anus,it also can be used as an auxiliary instrument for hemorrhoid surgery.WellCare Anoscope is composed of Anoscope, Introducer and Sleeve.The anoscopes are divided into the following models according to the way the components are configured and the differences in size : WellCare-ANO-Light Sterile . WellCare-ANO-Truncated Sterile.This is a single use, disposable device(s), provided sterile.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

anal sphincter, anus, and rectum

Indicated Patient Age Range

Not Found

Intended User / Care Setting

physicians

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

The non-clinical testing for WellCare Anoscope was performed to demonstrate verification testing in conformance with the acceptance criteria of test methods and recognized consensus standards. Tests included: Appearance, Physical Testing (compatibility, material strength), Chemical Testing (reducing substances, pH, EO/ECH residues, sterility), and Biocompatibility Testing (In Vitro Cytotoxicity, Skin Sensitization Test, Acute Systemic Toxicity Test, Pyrogen Test, Irritation Test). All tests passed their respective acceptance criteria. No clinical study was included in this submission.

Key Metrics

Not Found

Predicate Device(s)

K121135

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.

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" followed by the words "U.S. Food & Drug Administration".

December 22, 2023

Well Care (Wuhan) Medical Technology Co., Ltd Zhou Huimin Ouality Manager No. 11# The No.1 Road Fozuling of East Lake High-Tech Development Zone Wuhan, Hubei 430205 China

Re: K230439

Trade/Device Name: WellCare Anoscope Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope And Accessories Regulatory Class: Class II Product Code: FER Dated: November 21, 2023 Received: November 21, 2023

Dear Zhou Huimin:

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 (the 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 available 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.

1

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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).

2

Sincerely,

Shanil P. Haugen -S

Shanil P. Haugen, Ph.D. Assistant 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

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Indications for Use

510(k) Number (if known) K230439

Device Name WellCare Anoscope

Indications for Use (Describe)

WellCare Anoscope is intended for transanal use to provide physicians access to the anal sphincter, anus, and rectum and to perform various diagnostic and therapeutic procedures using additional accessories.

|--|

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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Section 3 510(k) Summary

l 510(k) Submitter

Device Submitter:Well care (Wuhan) medical technology Co., Ltd..
No. 11# The No. 1 road
Fozuling of East Lake High-Tech Development Zone Wuhan, Hubei

Contact Person: ZhouHuimin Quality Manager Phone: +86-15626465068 E-mail: wec-qm@wellcare.onaliyun.com

II Device

Trade Name of Device:WellCare Anoscope
Regulation Number:21 CFR 876.1500
Classification Name:Endoscope and acccessories
Product Code:FER
Regulation Number:21 CFR 876.1500
Regulatory ClassII
Review PanelGU - Gastroenterology-Urology

III Predicate Devices

510k NumberK121135
Trade Name of Device:Family of disposable,sterile and not sterile THD
Anoscope,Proctoscope , Rectoscope and Light-scope
Regulation Number:21 CFR 876.1500
Regulation Name:Endoscope and accessories
Regulatory ClassII
Product Code:FER

IV Device Description

WellCare Anoscope are intended for the examination of the anus,it also can be used as an auxiliary instrument for hemorrhoid surgery.WellCare Anoscope is composed of Anoscope, Introducer and Sleeve.The anoscopes are divided into the following models according to the way the components are configured and the differences in size : WellCare-ANO-Light Sterile . WellCare-ANO-Truncated Sterile.This is a single use, disposable device(s), provided sterile.

V Indications for use

WellCare Anoscope is intended for transanal use to provide physicians access to the anal sphincter, anus, and rectum and to perform various diagnostic and therapeutic procedures using additional accessories.

5

VI Technological Characteristics Comparison

VI-1: Comparison of WellCare Anoscope

| Device
Characteristic | Subject Device | Predicate Device
(K121135) | Discussion | | | | |
|--------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------|--------|-----------------------|--------|---------------------------|
| Indications
for Use | WellCare Anoscope is intended for
transanal use to provide physicians
access to the anal sphincter, anus,
and rectum and to perform various
diagnostic and therapeutic
procedures using additional
accessories. | Family of disposable,
sterile and not sterile THD
Anoscope, Proctoscope,
Rectoscope and
Light-scope is a single-use
anoscope with integrated
LED lighting, suitable for
performing diagnostic and
operational anoscopes.. | Identical | | | | |
| Operation
Principle | WellCare Anoscope opens up the
anal passage and then exits the
anus, and the anal passage is
continuously visualized by the
speculum, and Sleeve fixes the
perianal tissue at a certain angle
during PPH and RPH hemorrhoid
surgery, leaving a space and angle
suitable for the operation. Thus, it
can be used as an auxiliary
instrument for hemorrhoid surgery | Gently press the The
ANOSCOPES into the
anus and slowly enter, then
pull out the core, adjust the
light, and slowly exit from
deep to shallow, The
compact and
asymmetricaldesign of the
THD Surgy MaxiLED
allows easy access to the
analcanal without sphincter
traumaensuring good
dilation and anexcellent
view of the operatingfield | Identical | | | | |
| Design | WellCare Anoscope is composed of
Anoscope, Introducer and Sleeve, a
disposable illuminator and approved
light source. | The LightScope LED
anoscope combines ina
single device a light
anoscope and LED light
source. | Different
Comment
1 | | | | |
| Anoscope
material | medical polymer material PC | medical polymer material
PC | Identical | | | | |
| Size
(Unit: mm) | Anoscope | Introducer | Sleeve | | | | |
| | | | BEVELLED
diameter | length | TRUNCATED
diameter | length | Different
Comment
1 |

6

| | diamet
er | lengt
h | diamete
r | Heig
ht | diamet
er | er | h | er | h | |
|-------------------------|-----------------------------------------------------|------------|--------------|------------|--------------|---------------------------------------------|----|------|----|---------------------------|
| | | 41.1±1 | | | | 25 | 70 | 25 | 70 | |
| | 28.4±1 | | 28±1 | / | / | 21.7 | 91 | 21.7 | 91 | |
| | 28.4±1 | 41.1±1 | 28±1 | 114±2 | 26±1 | 15 | 65 | 15 | 65 | |
| | 28.4±1 | 41.1±1 | / | 114±2 | 26±1 | 22 | 90 | 22 | 90 | |
| | 19.9±1 | 80.2±1 | 19.5±1 | / | / | 26 | 90 | 26 | 90 | |
| Anoscope
Packaging | sealed bag, Individually packaged | | | | | sealed bag, Individually packaged | | | | Identical |
| Sterilization
method | Sterilized by Ethylene Oxide | | | | | Sterilized by Ethylene Oxide | | | | Identical |
| Light | a disposable illuminator and approved light source. | | | | | Self-light, with an integrated light source | | | | Different
Comment
1 |
| Singe Use
Only | disposable | | | | | disposable | | | | Identical |
| Shelf Life | 2 years | | | | | 2 years | | | | Identical |

Comment 1

The Design of the two are only different ,For example, in terms of size, dimensions, and light source design,But the actual intended use is the same, which does not affect the safety and effectiveness of the product.

Comment 2

The light source of the two are different,But the function is the same Therefore, the safety and effectiveness of the product will not be affected.

VII Summary of Non-clinical Testing (Bench)

The non-clinical testing for WellCare Anoscope was performed to demonstrate verification testing in conformance with the acceptance criteria of test methods and recognized consensus standards shown below.

Table VII-1: Performance testing was conducted on the subject device

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ID#TestMethodAcceptance CriteriaConclusion
1AppearanceThe shapeshouldbesmoothandsymmetrical, with nosharp edgesand no burrs in all parts.Themirror tube should be rounded, witha smooth inner walland a roundededgeatthewithouth eadend,burrs.Smooth surface of all parts no sharp edges,no burrs.Pass
2Physical Testing of Anoscope
2.1compatibilityTake 1 set of samples and test them manuallyThe anal expander and the guide mirror opened and closed easily with the scope, without swing and jam. The end of the anal expander should be smooth and anastomosed with the endoscope, and the maximum gap should not be greater than 0.6mm.Pass
2.2Material
strengthTake 1 set of samples, place the assembly horizontally and hang a 4 kg suspension in the middle of the assembly in accordance with the requirementsAny of the components (excluding the light source) should be able to withstand a 4 kg suspension without significant deformationPass
3Chemical Testing of Anoscope
3.1Reducing
substances
(oxide
prone)The sample was taken, configured at a ratio of 0.1g plus 1mL of water and then thermostated at 37°C ± 1°C for 8h, the sample was separated from the liquid and cooled to room temperature as the test solution. Take the same volume of water in a glass container and prepare a blank control solution by theThe difference in the volume of potassium permanganate solution [ c(1/5KMnO4) = 0.01 mol/L ] consumed by the test solution and the blank control solution should not exceed 2.0 mL0.4ml
3.2pHsame method
Take the test solution of 3.1
and the blank control
solution and determine their
pH values respectively with
an acidity meterthe difference between the pH
of the test solution and that of
the blank control solution
should not exceed 1.51.01
3.3EO/ECH
residuesISO 10993-7:2008average daily dose to patient
EO 4Biocompatibility Testing
4.1In Vitro
CytotoxicityISO 10995-5:2009Non-cytotoxicPass
4.2Skin
Sensitization
TestISO 10993-10:2021Non-sensitizerPass
4.3Acute
Systemic
Toxicity TestISO 10993-11:2017No systemic toxicityPass
4.4Pyrogen
TestISO 10993-11:2017Non-pyrogenPass
4.5Irritation TestISO 10993-23:2021Non-IrritationPass

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VIII Clinical Test Conclusion

No clinical study is included in this submission.

IX Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the WellCare Anoscope is as safe as effective, and performs as well as or better than the legally marketed device.