K Number
K964661
Device Name
HX-20/21-1 ENDOSCOPIC LIGATOR
Date Cleared
1997-10-30

(344 days)

Product Code
Regulation Number
876.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Olympus HX -20-1 Endoscopic Ligator has been designed to be used with Olympus endoscopes in delivering a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop designed to prevent or control bleeding following polypectompy of pedunculated polyps.
Device Description
The Olympus HX-20-1 Endoscopic Ligator is intended to deliver a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop to prevent or control bleeding following polypectomy of pedunculated polyps. The Olympus "EndoLoop"is substantially equivalent in intended use to endoscopic ligators marketed by Bard, Microvasive, and Wilson-Cook. The subject ligating device differs from these devices in that it operates via through-the-scope techniques.
More Information

Not Found

No
The summary describes a mechanical device for delivering ligation loops and makes no mention of AI or ML.

Yes.
The device is used to prevent or control bleeding following polypectomy, which falls under the definition of therapy.

No

Explanation: The device is described as an "Endoscopic Ligator" used to deliver ligation loops to prevent or control bleeding following polypectomy. Its function is interventional/therapeutic, not diagnostic.

No

The device description clearly indicates it is a physical endoscopic ligator designed to deliver ligation loops, which are hardware components. It is not described as software.

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

Here's why:

  • Intended Use: The intended use is to deliver a ligation loop to prevent or control bleeding following a medical procedure (polypectomy). This is a therapeutic/interventional use, not a diagnostic one.
  • Device Description: The description reinforces its function as a tool for delivering a physical loop to a site within the body.
  • Lack of Diagnostic Elements: There is no mention of analyzing samples (blood, tissue, etc.), detecting biomarkers, or providing diagnostic information.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device does not fit that description.

N/A

Intended Use / Indications for Use

The Olympus HX -20-1 Endoscopic Ligator has been designed to be used with Olympus endoscopes in delivering a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop, designed to prevent or control bleeding following polypectomy of pedunculated polyps.

Product codes

78 FHN, 78 MND

Device Description

The Olympus HX-20-1 Endoscopic Ligator is intended to deliver a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop to prevent or control bleeding following polypectomy of pedunculated polyps. The Olympus "EndoLoop"is substantially equivalent in intended use to endoscopic ligators marketed by Bard, Microvasive, and Wilson-Cook. The subject ligating device differs from these devices in that it operates via through-the-scope techniques.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

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)

Endoscopic Ligators by C.R. Bard, Wilson-Cook, and Microvasive

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.4400 Hemorrhoidal ligator.

(a)
Identification. A hemorrhoidal ligator is a device used to cut off the blood flow to hemorrhoidal tissue by means of a ligature or band placed around the hemorrhoid.(b)
Classification. Class II (special controls). Except for a hemostatic metal clip intended for use in the gastrointestinal tract, the device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

K 964661

510(k) SUMMARY OLYMPUS HX-20-1 ENDOSCOPIC LIGATOR

OCT 30 1997

Device Name:Olympus HX-20-1 Endoscopic Ligator
Common/Usual Name:HX-20-1 Endoscopic Ligator
Classification Name:Endoscope and Accessories
21 CFR 876.1500
Predicate Device:Endoscopic Ligators by C.R. Bard, Wilson-Cook, and
Microvasive
Contact Person:Laura Storms-Tyler
Olympus America, Inc.
Endoscope Division
2 Corporate Center Drive
Melville, NY 11747-3157
(516) 844-5688
Summary Preparation Date:October 22, 1997

Statement of Intended Use:

Olympus HX -20-1 Endoscopic Ligator has been designed to be used with Olympus endoscopes in delivering a MAI-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop designed to prevent or control bleeding following polypectompy of pedunculated polyps.

Device Description:

The Olympus HX-20-1 Endoscopic Ligator is intended to deliver a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop to prevent or control bleeding following polypectomy of pedunculated polyps. The Olympus "EndoLoop"is substantially equivalent in intended use to endoscopic ligators marketed by Bard, Microvasive, and Wilson-Cook. The subject ligating device differs from these devices in that it operates via through-the-scope techniques.

1

Image /page/1/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing right, resembling a bird-like shape.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 3 0 1997

Ms. Laura Storms-Tyler Director, Regulatory Affairs Endoscopic Division Olympus America, Inc. Two Corporate Center Drive Melville, New York 11747-3157 Re: K964661

HX-20/21-1 Endoscopic Ligator Dated: September 3, 1997 Received: September 4, 1997 Regulatory class: II 21 CFR §876.4400/Product code: 78 FHN and MND

Dear Ms. Storms-Tyler:

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 ass stated in the enelosure) to devices marketed in interstate commerce international 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, 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 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 Current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS 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 531 through 542 of the Act for devices under 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 predication 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) 594-4613. 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

W.Liau Yu
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

2

Indications for Use Statement

510(k) Number (if known):

Not assigned yet K 964661

Device Name:

Olympus HX-20-1 Endoscopic Ligator

Indications for Use:

The Olympus HX -20-1 Endoscopic Ligator has been designed to be used with Olympus endoscopes in delivering a MAJ-254 Standard Ligation Loop or MAJ-340 Small Ligation Loop, designed to prevent or control bleeding following polypectomy of pedunculated polyps.

Bober R. Sathing/

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Device 510(k) Number

Prescription Use
(Per 21 CFR 801.109)

Over-the-Counter Use_