K Number
K964131
Device Name
ENDOSCOPE
Date Cleared
1997-06-27

(255 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The endoscope system is used to examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures.
Device Description
The endoscope system includes the endoscope with control head, a disposable assembly, an imaging system, and a fluid and air system. The endoscope system features: 1) a smooth control head containing a minimal number of outside angles and joint crevices, 2) a single use disposable system encompassing all of the inner passage channels that start at the manifold, continue through the endoscope cavity, and seal onto the outside of the rigid distal tip, 3) a pneumatically driven air and fluid system eliminating the need for mechanical valves in the contamination path, and 4) a lavage function that provides a bolus of water through the working channel to loosen and flush debris from the field of view as the insertion tube advances through the colon.
More Information

None

No
The summary focuses on mechanical and fluidic aspects of the endoscope system and does not mention any AI or ML capabilities.

Yes
The "Intended Use / Indications for Use" section states that the system can "perform various diagnostic and therapeutic procedures."

Yes
The "Intended Use" states that the endoscope system is used to "examine body cavities, hollow organs and canals" and to "perform various diagnostic and therapeutic procedures," indicating its use in diagnosing conditions.

No

The device description explicitly details hardware components such as the endoscope with control head, disposable assembly, imaging system, and fluid and air system.

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

Here's why:

  • Intended Use: The intended use is to "examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures." This describes a device used for direct visualization and intervention within the body, not for testing samples taken from the body.
  • Device Description: The description details the components of an endoscope system used for internal examination and procedures. It focuses on the physical aspects of the device for insertion, imaging, and fluid/air management within the body.
  • Lack of IVD Characteristics: There is no mention of:
    • Analyzing biological samples (blood, urine, tissue, etc.).
    • Detecting or measuring substances in samples.
    • Providing information about a patient's health status based on sample analysis.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. This endoscope system is used for direct visualization and intervention within the body.

N/A

Intended Use / Indications for Use

The endoscope system is used to examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures.

The akos endoscope system is used to examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures.

Product codes

78KOG, 78 FAM, FDF

Device Description

The endoscope system includes the endoscope with control head, a disposable assembly, an imaging system, and a fluid and air system. The endoscope system features: 1) a smooth control head containing a minimal number of outside angles and joint crevices, 2) a single use disposable system encompassing all of the inner passage channels that start at the manifold, continue through the endoscope cavity, and seal onto the outside of the rigid distal tip, 3) a pneumatically driven air and fluid system eliminating the need for mechanical valves in the contamination path, and 4) a lavage function that provides a bolus of water through the working channel to loosen and flush debris from the field of view as the insertion tube advances through the colon.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lower GI tract (colon) only

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)

Not Found

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

Not Found

Predicate Device(s)

K853585, K951576, K951577, K951579, K951574, K932843, K933247, K921690, K921244, K944759, K933906, K954704, K950429, K801247

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.

0

K 964131
JUN 27 1997 P 10]

akos biomedical, inc. 6450 Lusk Blvd., Suite 109 San Diego, CA 92121

510(k) SUMMARY February 10, 1997

akos

voice: 619.450.6767 fax: 619.450.9249 e-mail: akos@cts.com

This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.

akos biomedical, inc. Submitter's Name and Address: Contact Person: Lacyne Avery Trade or Proprietary Name: To Be Determined Common Name: Endoscope Classification Name: Endoscope Device Class: Class II, within the Division of Gastroenterology-Urology Devices, Regulation Number: 21CFR Part 876.1500 Procode: 78KOG

Indications for Use: The endoscope system is used to examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures.

The endoscope system includes the endoscope with control head, a disposable Device Description: assembly, an imaging system, and a fluid and air system. The endoscope system features: 1) a smooth control head containing a minimal number of outside angles and joint crevices, 2) a single use disposable system encompassing all of the inner passage channels that start at the manifold, continue through the endoscope cavity, and seal onto the outside of the rigid distal tip, 3) a pneumatically driven air and fluid system eliminating the need for mechanical valves in the contamination path, and 4) a lavage function that provides a bolus of water through the working channel to loosen and flush debris from the field of view as the insertion tube advances through the colon.

Company Name510 (k) No.510(k) Description per CDRH Electronic Docket
Olympus CorporationK853585Olympus EVS-Endoscopic Video Image & Data Sys.
Pentax Precision Inst.K951576FS-34P2, Fiber Sigmoidoscope
K951577ES-3800, Video Sigmoidoscope
K951579EC-3800TL, Video Colonoscope
K951574EC-3800L, Video Colonoscope
Vision Sciences, Inc.K932843Flexible Video Sigmoidoscope System w/Disp. Sheath
K933247Protective Sheath - Flexible Nasopharyngo-Larygnoscope
K921690Flexible Fiberoptic Sigmoidoscope System
K921244Disposable Protective Sheath
Fujinon, Inc.K944759200 Series Gastro-Intestinal Video System
K933906Choledochoscope/Endoscope Modification
Welch Allyn, Inc.K954704VS-200 Video Sigmoidoscope
K950429Video Sigmoidoscope
K801247CCD Endoscope

Predicate Device 510(k) Information:

1

K464131 Proj 3

Sterilization: The Disposable Assembly will be marketed as "Sterile" - "Contents Are Sterile If Package Is Unopened and Undamaged", it will NOT be labeled as "pyrogen free." Sterilization with a SAL of 10-6 is to be performed by E-Beam radiation at TITAN Scan Systems, San Diego, California, using "Method I" as defined in the ANSVAAMI/ISO 11137-1994 "Sterilization of health care products - Requirements for validation and routine control - Radiation sterilization."

Safety Performance Specification / Standards (Applicable Sections):

FCC47 CFR Parts 0 to 19 (Part 18 is the applicable section)
UL 94Tests for Flammability of Plastic Materials for Parts in Devices and Appliances
UL 1572High Intensity Discharge Lighting Fixtures
UL 2601-1Medical Electrical Equipment, Part 1: General Requirements for Safety
CSAC22.2 No. 0.4-M1982 Bonding and Grounding of Electrical Equipment
CSAC22.2 No. 601.1 Medical Electrical Equipment, General Requirements for Safety
G95-1FDA Blue Book Memo - Required Biocompatibility Training and Toxicology Profiles for
Evaluation of Medical Devices
U.S.P.United States Pharmacopeia - Table 1. Classification of Plastics
ISO10993-1RBiological Evaluation of Medical Devices, Part 1: Evaluation and Testing
ISO 11137Sterilization of Health Care Products, Requirements for Validation and Routine Control,
Radiation Sterilization.
IEC 320-1Appliance Couplers for Household and Similar General Purposes
IEC 601-1Medical Electrical Equipment, Part 1: General Requirements
IEC 601-1-1Medical Electrical Equipment, Part 1: General Requirements for Safety
Collateral Standard: Safety Requirements for Medical Electrical Systems
IEC 601-1-2Medical Electrical Equipment, Part 1: General Requirements for Safety
Collateral Standard: Electromagnetic Compatibility - Requirements and Tests
IEC 601-2-18Medical Electrical Equipment, Part 2: Particular Requirements for the Safety of Endoscopic
Equipment
IEC 801-1Electromagnetic Compatibility for Industrial-Process Measurement and Control Equipment,
Part 1: General Introduction
IEC 801-5Electromagnetic Compatibility for Industrial-Process Measurement and Control Equipment,
Part 5: Surge Immunity Requirements
IEC 1000-4-2Electromagnetic Compatibility (EMC), Part 4: Testing and Measurement Techniques,
Section 2: Electrostatic Discharge Immunity Test Basic EMC Publication
IEC 1000-4-3Electromagnetic Compatibility (EMC), Part 4: Testing and Measurement Techniques,
Section 3: Radiated, Radio-Frequency, Electromagnetic Field Immunity Test
IEC 1000-4-4Electromagnetic Compatibility (EMC)
EN 50082-1Generic Immunity Standard for a Light Industrial Environment
EN 55011Limits and Methods of Measurement of Electromagnetic Disturbance Characteristics of
Industrial, Scientific and Medical (ISM) Radio Frequency Equipment CISPR 11
EN 60950Safety of Information Technology Equipment Including Electrical Business Equipment
4169-94ASTM Standard Practice for Performance Testing of Shipping Containers and Systems

$\rho_g$ 2 of 3

2

K964131

P3973

101V30 3TA210399 OT 2MO219A9M02 40 318A

akos (TBD)akos (TBD)Olympus CF-100SOlympus CF-130SOlympus E-GIFOlympus E-CFPentax FS-34P2Pentax ES-3801Pentax EC-3801S2Pentax EC-3400M
Viewing DirectionForwardForwardForwardForwardForwardForwardForwardForwardForwardForward
Optical Field of View135degrees125degrees140degrees140degrees113degrees133degrees120degrees120degrees120degrees120degrees
Optical Depth of Field5-100mm5-100mm5-100mm5-100mm8-65mm7-60mm3-100mm5-100mm5-100mm5-100mm
Rigid Tip Diameter13.7mm14.2mm15.4mm13.2mm11.4mm15.4mm11.5mm13.4mm13.4mm13.0mm
Bending Tip Deflection180up/dn 180r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left210up/90dn&100r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left
Bending OD13.4mm14mm13.8mm13.3mm11.2mm13.8mm11.5mm12.8mm12.8mm11.5mm
Insertion Tube Dia.13.2mm13.9mm13.3mm13.3mm11.4mm13.8mm11.5mm12.8mm12.8mm11.5mm
Insert. Working Length700mm1750mm620mm640mm1025mmI:1330 / L:1680mm700mm700mm1150mm1300mm
Biopsy Channel ID3.2mm3.8mm3.2mm3.2mm2.8mm3.2mm3.5mm1015mm1020mm1470mm1620mm
Total Length1020mm2070mm920mm935mm
Op. Env. Amb. Temp12-35deg C12-35deg C10-40deg C10-40deg C
Op. Env. R Humidity15-85 %15-85 %30-85 %30-85 %
Atmospheric Pressure70-106kPa70-106kPa700-1060mbars70-106kPa
Disposable ChannelsYesYesNoNoNoNoNoNoNoNo
Vision Sci. VS12000Vision Sci. S-F100Fujinon COL-ST2/LT2Fujinon SIG-ET2Fujinon COL-MP/LP2Fujinon SIG-GPFujinon EC7-MR/LR2Fujinon ES7-ER2Fujinon EC7-MT/LT2Welch Allyn FX-100
Viewing DirectionForwardForwardForwardForwardForwardForwardForwardForwardForwardForward
Optical Field of View120degrees120degrees110degrees110degrees105degrees105degrees125degrees125degrees125degrees100degrees
Optical Depth of Field3-100mm4-120mm observation4-120mm observation4-120mm observ.3-100mm observ.5-100mm observ.5-100mm observ.5-100mm observ.5-100mm observ.3-100mm focal
Rigid Tip Diameter13.8mm14.0mm14.0mm14.0mm11.5mm11.8mm13.0mm13.0mm14.3mm13.5mm
Bending Tip Deflection180up/dn 160r/left180up/dn 150r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left180up/dn 160r/left180up/dn 180r/left180up/dn 180r/left180up/dn 160r/left180up/dn 150r/left
Bending OD14.0mm14.0mm14.0mm14.0mm11.5mm11.8mm13.0mm13.0mm14.3mm13.5mm
Insertion Tube Dia.12.8mm12.8mm12.8mm12.8mm11.5mm11.8mm13.0mm13.0mm14.0mm13.5mm
Insert. Working Length65cm65cm1010-1735mm765mm1475-1735650mm1520-1770mm790mm1520-1770mm65cm
Biopsy Channel ID3.2mm3.2mm4.3mm4.3mm3.2mm3.2mm3.2mm3.2mm4.3mm3.2mm
Total Length1265-1990mm1020mm1730-1990mm980mm1850-2100mm1120mm1850-2100mm
Op. Env. Amb. Temp
Op. Env. R Humidity
Atmospheric Pressure
Disposable ChannelsYesYesNoNoNoNoNoNoNoNo

Page 3 of 3

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle or bird-like figure with three curved lines representing its body and wings. The logo is surrounded by text that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" in a circular arrangement.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 27 1997

Ms. Lacyne Y. Avery Director, Quality Assurance and Regulatory Affairs Akos Biomedical, Inc. 6450 Lusk Boulevard, Suite 109 San Diego, California 92121

Re:K964131
Video Endoscope System
Dated:April 11, 1997
Received:April 14, 1997
Regulatory class:II
21 CFR §876.1500/Product code:78 FAM and FDF

Dear Ms. Avery:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may; therefore, market the device, subject to the general controls provisions of the Act. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Good Manufacturing Practice for Medical Devices: General (GMP) regulation (21 CFR Part 820) and that, through periodic GMP inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 53 1 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4616. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

Lillian Yin, Ph.D.

Director. Division of Reproductive. Abdominal, Ear, Nose and Throat and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4


Page_1 of _1

K964131 510(k) Number (if known): Video Endoscope System Device Name:__________________________________________________________________________________________________________________________________________________________________

Indications For Use:

The akos endoscope system is used to examine body cavities, hollow organs and canals, specifically the lower GI tract (colon) only, and, using additional accessories, to perform various diagnostic and therapeutic procedures.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Robert R. Silling/

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Devices 510(k) Number_KG64131

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)