K Number
K233229
Device Name
NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether
Date Cleared
2024-01-05

(99 days)

Product Code
Regulation Number
876.1300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The NaviCam Small Bowel (SB) Capsule Endoscopy System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from 2 years of age. The NaviCam Tether is an accessory of the NaviCam SB Capsule. It is intended to aid the capsule for visualizing the esophagus prior to the capsule's release into the gastrointestinal tract for a SB capsule endoscopy procedure in adults (≥ 22 years).
Device Description
The NaviCam Small Bowel Capsule Endoscopy System is an endoscopic capsule imaging system intended to obtain images of the small bowel. It is comprised of the following components: - a. Capsule: The disposable, ingestible NaviCam Small Bowel Capsule is designed to acquire video images during the natural propulsion through the GI tract. The capsule transmits the acquired images via an RF communication channel to the NaviCam Data Recorder located outside the body. - Data recorder: The Data Recorder is an external receiving/recording unit that receives b. and stores the acquired images from the capsule. - ESView Software: The ESView is a software application for processing, analyzing, c. storing, and viewing the acquired images collected from the NaviCam Data Recorder to create a video of the images. The software also includes a reporting function to create detailed clinical reports and a capsule endoscopy atlas. - Locator: The Locator is a handheld device that is used to turn the NaviCam Capsule d. on. It is also used for determining if the capsule is still in the body when the patient is not sure whether he/she expelled it. - e. Tether: The NaviCam Tether is a disposable product, which serves as an accessory to the NaviCam SB Capsule to allow for examination of the esophagus prior to releasing the NaviCam SB Capsule into the small bowel.
More Information

No
The summary describes image processing software but does not mention AI, ML, or any related terms like deep learning or neural networks.

No.
The device is intended for visualization and detection of abnormalities, not for providing therapy or treatment.

Yes

The device is intended for "visualization of the small bowel mucosa" and "may be used as a tool in the detection of abnormalities of the small bowel," which are diagnostic purposes. The ESView Software also has a "reporting function to create detailed clinical reports," further supporting its role in diagnosis.

No

The device description clearly lists multiple hardware components (Capsule, Data recorder, Locator, Tether) in addition to the software (ESView Software).

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

Here's why:

  • Intended Use: The intended use is for "visualization of the small bowel mucosa" and "detection of abnormalities of the small bowel." This is a diagnostic procedure performed in vivo (within the living body) using imaging.
  • Device Description: The components described (capsule, data recorder, software, locator, tether) are all designed for capturing and processing images from inside the body.
  • Lack of In Vitro Components: There are no mentions of reagents, test strips, or any components designed to analyze biological samples outside the body.
  • Anatomical Site: The device operates within the small bowel and esophagus, which are internal anatomical sites.
  • Performance Studies: The performance studies described focus on clinical experience and bench testing related to the imaging and physical performance of the device within the body. There are no studies related to the analysis of biological samples.

IVD devices are specifically designed to perform tests on biological samples (like blood, urine, tissue) in vitro to provide information for diagnosis, monitoring, or screening. This device is an in vivo imaging system.

N/A

Intended Use / Indications for Use

The NaviCam Small Bowel (SB) Capsule Endoscopy System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from 2 years of age.

The NaviCam Tether is an accessory of the NaviCam SB Capsule. It is intended to aid the capsule for visualizing the esophagus prior to the capsule's release into the gastrointestinal tract for a SB capsule endoscopy procedure in adults (≥ 22 years).

Product codes

NEZ, QUN

Device Description

The NaviCam Small Bowel Capsule Endoscopy System is an endoscopic capsule imaging system intended to obtain images of the small bowel. It is comprised of the following components:

  • a. Capsule: The disposable, ingestible NaviCam Small Bowel Capsule is designed to acquire video images during the natural propulsion through the GI tract. The capsule transmits the acquired images via an RF communication channel to the NaviCam Data Recorder located outside the body.
  • b. Data recorder: The Data Recorder is an external receiving/recording unit that receives and stores the acquired images from the capsule.
  • c. ESView Software: The ESView is a software application for processing, analyzing, storing, and viewing the acquired images collected from the NaviCam Data Recorder to create a video of the images. The software also includes a reporting function to create detailed clinical reports and a capsule endoscopy atlas.
  • d. Locator: The Locator is a handheld device that is used to turn the NaviCam Capsule on. It is also used for determining if the capsule is still in the body when the patient is not sure whether he/she expelled it.
  • e. Tether: The NaviCam Tether is a disposable product, which serves as an accessory to the NaviCam SB Capsule to allow for examination of the esophagus prior to releasing the NaviCam SB Capsule into the small bowel.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Video images acquired by an ingestible capsule.

Anatomical Site

Small bowel mucosa, esophagus

Indicated Patient Age Range

Adults and children from 2 years of age for the NaviCam Small Bowel (SB) Capsule Endoscopy System.
Adults (≥ 22 years) for the NaviCam Tether.

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)

Clinical Experience: A summary of clinical publications for children between the ages of 2 and 21.
Current Publications (2011-2022): 9 studies, total 843 patients, average age 11.3 years, min age 1 year, max age 23 years.
Meta-Analysis (2001-2010): 1 study, 723 patients, average age 11.0 years, min age 0.8 years, max age 18 years.
Overall Totals/Avg/Min/Max: 1566 patients, 11.1 years, 0.8 years, 23 years.

Key results: The clinical data confirms the original meta-analysis and supports the use of small bowel capsule endoscopy in children to 2 years old. The NaviCam SB Capsule and the PillCam SB Capsule are essentially the same size, thus the clinical data proves that the NaviCam Small Bowel Capsule is safe for use in children.

Bench Testing:
The NaviCam SB Capsule Endoscope System demonstrated compliance to the Special Controls in the previous submissions (K221590) and the hardware/software of the system has not changed but only the NaviCam Tether and the packaging. Bench testing confirms compliance with the Special Controls for the NaviCam Tether and the new packaging.
All the V&V tests of the NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether successfully met their acceptance criteria thus validating the performance of the system without raising any new safety or effectiveness concerns.

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

Not Found

Predicate Device(s):

Given PillCam Platform with PillCam SB Capsules, Given AGILE Patency System (K090557)

Reference Device(s):

NaviCam Capsule Endoscope System with NaviCam Stomach Capsule and NaviCam Tether, NaviCam Xpress Stomach Capsule Endoscope System (NaviCam Express Stomach System) with NaviCam Stomach Capsule and NaviCam Tether (K221608)

Predetermined Change Control Plan (PCCP) - All Relevant Information

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 is the Department of Health & Human Services logo. To the right of that is the FDA logo, which consists of the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

January 5, 2024

AnX Robotica Corporation Tim Thomas VP, Regulatory/Quality/Clinical 6010 W Spring Creek Parkway Plano, Texas 75024

Re: K233229

Trade/Device Name: NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether Regulation Number: 21 CFR 876.1300 Regulation Name: Ingestible Telemetric Gastrointestinal Capsule Imaging System Regulatory Class: Class II Product Code: NEZ, QUN Dated: December 3, 2023 Received: December 6, 2023

Dear Tim Thomas:

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.

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).

1

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 OS 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 medical devices and radiation-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) K233229

Device Name

NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether

Indications for Use (Describe)

The NaviCam Small Bowel (SB) Capsule Endoscopy System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from 2 vears of age.

The NaviCam Tether is an accessory of the NaviCam SB Capsule. It is intended to aid the capsule for visualizing the esophagus prior to the capsule's release into the gastrointestinal tract for a SB capsule endoscopy procedure in adults (≥ 22 years).

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)

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NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether Section 6: 510(k) Summary v2

510(K) SUMMARY

NaviCam Small Bowel Capsule Endoscope System with NaviCam SB Capsule and NaviCam Tether

510(k) Number K233229

SUBMITTER 1.

Applicant's Name: AnX Robotica Corporation 6010 W. Spring Creek Parkway Plano, TX 75024 Phone: (469) 606-9495

Primary Contact: Tim Thomas, RAC VP, Regulatory/Quality/Clinical Phone: (770) 480-2911 Email: tim.thomas@anxrobotics.com

2. DATE PREPARED 9/28/2023

    1. DEVICE
Trade Name:NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether
Classification Code:Name: Ingestible telemetric gastrointestinal capsule imaging system
Product Codes: NEZ, QUN
Regulation No: 876.1300
Class: II

Classification Panel: Gastroenterology/Urology

4. PREDICATE DEVICES

Primary - Given PillCam Platform with PillCam SB Capsules, Given AGILE Patency System (K090557).

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Reference - NaviCam Capsule Endoscope System with NaviCam Stomach Capsule and NaviCam Tether, NaviCam Xpress Stomach Capsule Endoscope System (NaviCam Express Stomach System) with NaviCam Stomach Capsule and NaviCam Tether (K221608).

5. DEVICE DESCRIPTION

The NaviCam Small Bowel Capsule Endoscopy System is an endoscopic capsule imaging system intended to obtain images of the small bowel. It is comprised of the following components:

  • a. Capsule: The disposable, ingestible NaviCam Small Bowel Capsule is designed to acquire video images during the natural propulsion through the GI tract. The capsule transmits the acquired images via an RF communication channel to the NaviCam Data Recorder located outside the body.
  • Data recorder: The Data Recorder is an external receiving/recording unit that receives b. and stores the acquired images from the capsule.
  • ESView Software: The ESView is a software application for processing, analyzing, c. storing, and viewing the acquired images collected from the NaviCam Data Recorder to create a video of the images. The software also includes a reporting function to create detailed clinical reports and a capsule endoscopy atlas.
  • Locator: The Locator is a handheld device that is used to turn the NaviCam Capsule d. on. It is also used for determining if the capsule is still in the body when the patient is not sure whether he/she expelled it.
  • e. Tether: The NaviCam Tether is a disposable product, which serves as an accessory to the NaviCam SB Capsule to allow for examination of the esophagus prior to releasing the NaviCam SB Capsule into the small bowel.

6. INDICATIONS FOR USE

The NaviCam Small Bowel (SB) Capsule Endoscopy System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from 2 years of age.

The NaviCam Tether is an accessory of the NaviCam SB Capsule. It is intended to aid the Capsule for visualizing the esophagus prior to the capsule's release into the gastrointestinal tract for a SB capsule endoscopy procedure in adults ( ≥ 22 years).

7. SUBSTANTIAL EQUIVALENCE Indications

The proposed indications for use of the NaviCam Small Bowel Capsule Endoscope System with NaviCam SB Capsule and NaviCam Tether are:

The NaviCam Small Bowel Capsule Endoscopy System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two years of age.

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The NaviCam Tether is an accessory of the NaviCam SB Capsule. It is intended to aid the Capsule for visualizing the esophagus prior to the capsule's release into the gastrointestinal tract for a SB capsule endoscopy procedure in adults (≥22 years).

The first part of the indications for use of the NaviCam Small Bowel Capsule Endoscope System with NaviCam SB Capsule and NaviCam Tether are the exactly the same to the indications for use of the FDA clearance for the Given PillCam Platform with PillCam SB Capsules, Given AGILE Patency System (K090557):

The Given PillCam® Platform with the PillCam SB Capsules is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two vears of age.

The second part of the indications for use of the NaviCam Small Bowel Capsule Endoscope System with NaviCam SB Capsule and NaviCam Tether are the same as the second part of the indications for use of the FDA clearance NaviCam Capsule Endoscope System with NaviCam Stomach Capsule and NaviCam Tether, NaviCam Xpress Stomach Capsule Endoscope System (NaviCam Express Stomach System) with NaviCam Stomach Capsule and NaviCam Tether (K221608) except for clarifying small bowel instead of stomach as the next capsule endoscope procedure along with removing "not magnetically maneuvered" since the NaviCam SB capsule is not magnetically maneuvered:

The NaviCam Stomach Capsule is intended for visualization of the stomach of adults (>/=22 vears) with BMI 22 years of age.

Bench Testing

The NaviCam SB Capsule Endoscope System demonstrated compliance to the Special Controls in the previous submissions (K221590) and the hardware/software of the system has not changed but only the NaviCam Tether and the packaging. Bench testing confirms compliance with the Special Controls for the NaviCam Tether and the new packaging.

All the V&V tests of the NaviCam Small Bowel Capsule Endoscopy System with NaviCam SB Capsule and NaviCam Tether successfully met their acceptance criteria thus validating the performance of the system without raising any new safety or effectiveness concerns.

CONCLUSION 9.

The expansion of the indications for use does not affect the performance of its parent device, the NaviCam Small Bowel Endoscope System, and does not pose any new risks to the patient as demonstrated using the device in clinical settings.

The change from sterile to non-sterile does not affect the performance of its parent device. the NaviCam Small Bowel Endoscope System, and does not pose any new risks to the patient as demonstrated by over 20 years of utilizing a non-sterile small bowel capsule in clinical use and clinical trials.

The change to pre-assembled capsule and tether does not affect the performance of its parent device, NaviCam Capsule Endoscope System with NaviCam Stomach Capsule and NaviCam Tether, NaviCam Xpress Stomach Capsule Endoscope System (NaviCam Express Stomach System) with NaviCam Stomach Capsule and NaviCam Tether and does not pose any new risks to the patient. This change reduces risk by having a pre-assembled capsule and tether vs. having health care providers attach the capsule to the tether which is inherently more variable than the manufacturing process.