K Number
K230991
Device Name
PillCam SB 3 capsule endoscopy system, PillCam Software 9.0E
Date Cleared
2023-06-30

(85 days)

Product Code
Regulation Number
876.1300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The PillCam SB 3 capsule is intended for visualization of the small bowel mucosa. - . It may be used in the visualization and monitoring of lesions that may indicate Crohn's disease not detected by upper and lower endoscopy. - . It may be used in the visualization and monitoring of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy. - It may be used in the visualization and monitoring of lesions that may be potential causes of iron deficiency anemia (IDA) not detected by upper and lower endoscopy. The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas. The PillCam SB 3 capsule may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age.
Device Description
The subject device, PillCam Cloud Reader SW, is an additional cloud data management option which enables users to review PillCam CE videos stored on the public cloud repository. The PillCam Cloud Reader SW utilizes Amazon Cloud Services (also referred to as "HCP Cloud" or "AWS") offering a vast standardized, robust, and verified platform that facilities multiple containers while utilizing various cloud services. AWS enables easy and efficient scaling up and down, leveraging the system's efficiency for the PillCam Cloud Reader SW. The AWS cloud environment is comprised of 2 components: the Cloud Reader Video Storage and HCP Software Application, refer to Section 5.3 for further technological details of each component. The PillCam Sync Agent is a local software component that is installed in the PillCam Software 9.0E workstation. The PSA continuously sycronizes the local data from the local database (predicate component #4 in the figure below) back and forth to the PillCam Cloud Reader Video Storage component.
More Information

Not Found

No
The document explicitly states that the software "does not process and/or analyze acquired images" and "Input videos are displayed with no processing or alteration." There is no mention of AI, ML, or related technologies.

No.
The device itself (PillCam Cloud Reader SW) is a software application for viewing and managing video data from the PillCam capsule, which is a diagnostic tool, not a therapeutic one. The description explicitly states it "does not process and/or analyze acquired images" and acts as a data management tool for diagnostic visualization.

Yes

The device, described as "PillCam SB 3 capsule," is intended for "visualization of the small bowel mucosa" to "monitor lesions that may indicate Crohn's disease," "may be a source of obscure bleeding," or "may be potential causes of iron deficiency anemia." It is also stated to be a "tool in the detection of abnormalities of the small bowel." These uses directly relate to identifying and diagnosing medical conditions. The "PillCam Cloud Reader SW" discussed is a companion software for viewing these diagnostic videos, not the diagnostic device itself.

No

The device description explicitly states that the subject device, PillCam Cloud Reader SW, is an "additional cloud data management option" and relies on the "PillCam SB 3 capsule" and the "PillCam Software 9.0E workstation component" for image acquisition and video compilation. These are hardware components and associated software that are integral to the overall system, making the PillCam Cloud Reader SW a software component of a larger medical device system that includes hardware.

Based on the provided information, the PillCam SB 3 capsule is the device that fits the description of an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The PillCam SB 3 capsule is intended for "visualization of the small bowel mucosa" and is used to visualize and monitor lesions that "may indicate Crohn's disease," "may be a source of obscure bleeding," or "may be potential causes of iron deficiency anemia." While not a traditional laboratory test, the act of visualizing the internal mucosa to identify potential disease indicators falls under the broad definition of providing information for diagnosis or monitoring of a disease or condition.
  • Device Description: The description focuses on the capsule itself, which is ingested and collects data from within the body.
  • Input Imaging Modality: It's an "Ingestible telemetric gastrointestinal capsule imaging system," which is the core component that interacts with the patient's internal environment.
  • Anatomical Site: It specifically targets the "small bowel mucosa."

The PillCam Cloud Reader SW and PillCam Sync Agent are described as software components that manage and display the data collected by the capsule. They are tools for reviewing the images and creating reports, but they do not directly interact with the patient's biological samples or provide diagnostic information themselves. They are more akin to a viewing station and data management system for the IVD device (the capsule).

Therefore, the PillCam SB 3 capsule is the IVD in this scenario.

N/A

Intended Use / Indications for Use

The PillCam SB 3 capsule is intended for visualization of the small bowel mucosa.

  • It may be used in the visualization and monitoring of lesions that may indicate Crohn's disease not detected by upper and lower endoscopy.
  • . It may be used in the visualization and monitoring of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy.
  • It may be used in the visualization and monitoring of lesions that may be potential causes of ● iron deficiency anemia (IDA) not detected by upper and lower endoscopy.

The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas.

The PillCam SB 3 capsule may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age.

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

NEZ

Device Description

The subject device, PillCam Cloud Reader SW, is an additional cloud data management option which enables users to review PillCam CE videos stored on the public cloud repository.

The PillCam Cloud Reader SW utilizes Amazon Cloud Services (also referred to as "HCP Cloud" or "AWS") offering a vast standardized, robust, and verified platform that facilities multiple containers while utilizing various cloud services. AWS enables easy and efficient scaling up and down, leveraging the system's efficiency for the PillCam Cloud Reader SW.

The AWS cloud environment is comprised of 2 components: the Cloud Reader Video Storage and HCP Software Application, refer to Section 5.3 for further technological details of each component.

The PillCam Sync Agent is a local software component that is installed in the PillCam Software 9.0E workstation. The PSA continuously sycronizes the local data from the local database (predicate component #4 in the figure below) back and forth to the PillCam Cloud Reader Video Storage component.

Mentions image processing

PillCam Cloud Reader is a software application that is utilized to view videos and create reports and does not process and/or analyze acquired images. Input videos are displayed with no processing or alteration. The compilation of the video from the acquired images is still conducted using the predicate device PillCam capsule endoscopy system with PillCam Software 9.0E workstation component.

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

small bowel

Indicated Patient Age Range

adults and children from two years of age

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)

Not Found

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.

K211684

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

§ 876.1300 Ingestible telemetric gastrointestinal capsule imaging system.

(a)
Identification. An ingestible telemetric gastrointestinal capsule imaging system is used for visualization of the small bowel mucosa as an adjunctive tool in the detection of abnormalities of the small bowel. The device captures images of the small bowel with a wireless camera contained in a capsule. This device includes an ingestible capsule (containing a light source, camera, transmitter, and battery), an antenna array, a receiving/recording unit, a data storage device, computer software to process the images, and accessories.(b)
Classification. Class II (special controls). The special control is FDA's guidance, “Class II Special Controls Guidance Document: Ingestible Telemetric Gastrointestinal Capsule Imaging Systems; Final Guidance for Industry and FDA.”

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left side of the image is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the FDA logo is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

June 30, 2023

Given Imaging Ltd. (Medtronic) Breanna Hessler Sr. Regulatory Affairs Specialist 2 Hacarmel St. New Industrial Park, PO Box 258 Yogneam. 20692 ISRAEL

Re: K230991

Trade/Device Name: PillCam SB 3 capsule endoscopy system, PillCam Software 9.0E Regulation Number: 21 CFR 876.1300 Regulation Name: Ingestible telemetric gastrointestinal capsule imaging system Regulatory Class: Class II Product Code: NEZ Dated: June 20, 2023 Received: June 21, 2023

Dear Breanna Hessler:

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

1

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/combination-products/guidance-regulatory-information/postmarketing-safetyreporting-combination-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 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-devices/medical-device-safety/medicaldevice-reporting-mdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medical-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-devices/device-advicecomprehensive-regulatory-assistance/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 -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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510(k) Number (if known) K230991

Device Name

PillCam SB 3 Capsule Endoscopy System PillCam Software 9.0E Indications for Use (Describe)

The PillCam SB 3 capsule is intended for visualization of the small bowel mucosa.

  • . It may be used in the visualization and monitoring of lesions that may indicate Crohn's disease not detected by upper and lower endoscopy.
  • . It may be used in the visualization and monitoring of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy.
  • It may be used in the visualization and monitoring of lesions that may be potential causes of iron deficiency anemia (IDA) not detected by upper and lower endoscopy.

The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas.

The PillCam SB 3 capsule may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age.

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF

Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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FORM FDA 3881 (6/20)

0051

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1.0 510(k) SUMMARY

Given Imaging Ltd. (d.b.a. Medtronic Inc.) PillCam SB 3 Capsule Endoscopy System with

PillCam Software 9.0E (including PillCam Cloud Reader Software)

Date Prepared: June 9, 2023

  • Submitter: Given Imaging Ltd. (d.b.a. Medtronic) 2 Hacarmel St. New Industrial Park, PO Box 258 Yoqneam, 20692 Israel Phone: (763) 398-7010
  • Contact Person: Breanna Hessler Sr. Regulatory Affairs Specialist Gastrointestinal Health, Medtronic Phone: 763-591-36530 Email: Breanna.Hessler@medtronic.com

Alternate Contact: Angelina Lisandrelli Principal Regulatory Affairs Speicalist Gastrointestinal Health, Medtronic Phone: 763-505-3150 Email: angelina.m.lisandrelli(@medtronic.com

Name of Device:

PillCam SB 3 Capsule Endoscopy System with PillCam Software 9.0E (including PillCam Cloud Reader Software)

Common or Usual Name:

Ingestible telemetric gastrointestinal capsule imaging system

Classification:

System, Imaging, Gastrointestinal, Wireless, Capsule

Requlatory Class:

Class II, 21 CFR 876.1300

Product Code:

NEZ

Predicate Device:

PillCam SB 3 Capsule Endoscopy System with PillCam Software 9.0E (K211684)

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Subject Device Description:

The subject device, PillCam Cloud Reader SW, is an additional cloud data management option which enables users to review PillCam CE videos stored on the public cloud repository.

The PillCam Cloud Reader SW utilizes Amazon Cloud Services (also referred to as "HCP Cloud" or "AWS") offering a vast standardized, robust, and verified platform that facilities multiple containers while utilizing various cloud services. AWS enables easy and efficient scaling up and down, leveraging the system's efficiency for the PillCam Cloud Reader SW.

The AWS cloud environment is comprised of 2 components: the Cloud Reader Video Storage and HCP Software Application, refer to Section 5.3 for further technological details of each component.

The PillCam Sync Agent is a local software component that is installed in the PillCam Software 9.0E workstation. The PSA continuously sycronizes the local data from the local database (predicate component #4 in the figure below) back and forth to the PillCam Cloud Reader Video Storage component.

Intended Use/Indications for Use:

The PillCam SB 3 capsule is intended for visualization of the small bowel mucosa.

  • It may be used in the visualization and monitoring of lesions that may indicate Crohn's disease not detected by upper and lower endoscopy.
  • . It may be used in the visualization and monitoring of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy.
  • It may be used in the visualization and monitoring of lesions that may be potential causes of ● iron deficiency anemia (IDA) not detected by upper and lower endoscopy.

The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas.

The PillCam SB 3 capsule may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age.

Technological Characteristics:

The proposed PillCam Cloud Reader is an optional reporting subcomponent of the predicate device PillCam SB 3 Capsule Endoscopy System with PillCam Software 9.0E. PillCam Cloud Reader allows physicians to remotely view and report videos that have been generated with PillCam Software 9.0E. PillCam Cloud Reader implements a similar user interface as the existing video viewing and reporting web subcomponent within the PillCam Software 9.0E subsystem, while implementing a different cloud-enabled back end to add scalability and efficiency.

PillCam Cloud Reader is a software application that is utilized to view videos and create reports and does not process and/or analyze acquired images. Input videos are displayed with no processing or alteration. The compilation of the video from the acquired images is still conducted using the predicate device PillCam capsule endoscopy system with PillCam Software 9.0E workstation component.

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Non-Clinical Performance Assessment:

The protocols, test methods, and acceptance criteria used for verification of the proposed PillCam Cloud Reader are well established methods. The information summarized in Table 7-1: Design Controls Activities Summary for PillCam Cloud Reader Software, including related risks and risk mitigations, are based on the PillCam Cloud Reader Software risk management plan and summary. These well established methods are in agreement with recommendations in the applicable FDA recognized census standards listed in Section 9.0.

Conclusion:

Medtronic believes that the proposed PillCam capsule endoscopy system with PillCam Software 9.0E (including PillCam Cloud Reader) is substantially equivalent with no impact to safety, efficacy or performance to the device.