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510(k) Data Aggregation

    K Number
    K243039
    Date Cleared
    2025-06-18

    (264 days)

    Product Code
    Regulation Number
    876.4620
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    Ureteral Stents (AF-D series) are used for temporary internal drainage from the ureteropelvic junction to the bladder. Ureteral Stents have been used to relieve obstruction in a variety of benign, malignant, and post-traumatic conditions. The stents may be placed using endoscopic, percutaneous, or open surgical techniques. The indwelling time should not exceed 30 days.

    Device Description

    Ureteral Stents (AF-D series) are a set of ureteral stents used for temporary internal drainage from the ureteropelvic junction to the bladder. The subject ureteral stent is a flexible, tubular double pigtail stent composed of thermoplastic polyurethane with hydrophilic coating. Depending on configurations, the device may include a ureteral stent only, or a stent with an introducer and a clamp, or a stent with an introducer, a guidewire and a clamp.
    Ureteral Stents are available in 4.0 to 7.0 French (Fr) diameter, with lengths ranging from 8.0 to 28.0 centimeters (cm). The device is supplied sterile, intended for single use only, and is available for prescription use only.
    Ureteral Stents are not intended as a permanent indwelling device. The subject stent is labeled for indwell time not to exceed thirty (30) days only.

    AI/ML Overview

    The provided FDA 510(k) clearance letter and summary for the Ureteral Stents (AF-D series) do not describe a study involving an AI/Machine Learning device or software. The information focuses on the substantial equivalence of a physical medical device (Ureteral Stents) to a predicate device based on material properties, design, and physical performance characteristics.

    Therefore, it is impossible to extract the requested information (acceptance criteria, details of a study proving the device meets criteria, sample sizes, expert involvement, ground truth, MRMC study, training sets) as these pertain specifically to the validation of AI/ML models, not traditional medical devices like ureteral stents.

    The document covers:

    • Acceptance Criteria (Implicitly): The acceptance criteria are implicitly that the device performs as safely and effectively as the predicate device across various bench tests and biocompatibility assessments.
    • Study Proving Acceptance (Bench Testing): The document states: "A battery of bench testing based on the FDA guidance 'Guidance for the Content of Premarket Notification for Ureteral Stents' (1993) was conducted on the subject, predicate and reference stents using established methods and standards to demonstrate the performance substantial equivalence to the predicate device."
      • Tests listed: Appearance and Dimensions, Curl Retention Test (pigtails), Break Strength & Elongation, Flow Rate, Dynamic Friction Force, Kink Stability Test, Simulated Stent Insertion and Removal Test, Chemical Performance, Guidewire: Radiopacity, bending test, compatibility with stent and introducer.
      • Biocompatibility Testing: Cytotoxicity, Sensitization, Intracutaneous Reactivity, Acute Systemic Toxicity, Material-Mediated Pyrogenicity, Subacute Systemic Toxicity, Muscle Implantation, Genotoxicity.
      • Sterility and Shelf Life: SAL of 10⁻⁶ (ISO 11135:2014), packaging integrity, accelerated aging study, and simulated transportation study.
    • Sample Size: The document does not specify the sample size for the physical device testing. It refers to "representative device models" for shelf life testing and "a battery of bench testing," which implies multiple units were tested but no specific number is given.
    • Data Provenance: Not applicable in the context of AI/ML. The "data" here refers to physical test results from the manufactured stents.
    • Experts and Ground Truth: Not applicable in the context of clinical AI/ML validation involving human readers. For physical device testing, adherence to established standards and methods serves as the "ground truth."
    • MRMC, Standalone Performance, Training Set details: These are all concepts relevant to AI/ML device validation and are not discussed as this is a physical medical device.

    In summary, the provided document describes the regulatory clearance of a physical medical device (Ureteral Stents) through a substantial equivalence pathway, not an AI/Machine Learning device. Therefore, the specific questions related to AI/ML validation cannot be answered from this document.

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    K Number
    K242635
    Date Cleared
    2025-05-30

    (269 days)

    Product Code
    Regulation Number
    876.1500
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    Endoscopic Distal Attachment is intended to be used in combination with compatible endoscopes to maintain the field of view during endoscopic procedures such as mucosal resection.

    Device Description

    The Endoscopic Distal Attachment is an additional device, made of TPU designed to attach to the distal end of the endoscope. The device is composed of three main portions: an attaching portion, a distal portion, and a drain portion. The attaching portion is a wider diameter opening which is used to connect the attachment to a compatible endoscope; the distal portion is the ending portion of the attachment which tapers into narrower diameter opening. The hole, which is only available for some models, forms drain portion which prevent the fluids lodging on the surface of the endoscope.

    The Endoscopic Distal Attachment can be used in combination with compatible endoscopes to maintain an appropriate endoscopic field of view.

    The Endoscopic Distal Attachment has six models, depending on different surface design (flat or incline), with or without hole and with scale or without scale. The models include models of flat face without hole, flat face with hole, inclined face without hole, inclined face with hole, flat face without hole with scale and flat face.

    AI/ML Overview

    This document is a 510(k) clearance letter for a medical device called "Endoscopic Distal Attachment (AF-D series)". Based on the provided text, the device is not an AI/Software as a Medical Device (SaMD). It is a physical accessory made of TPU that attaches to endoscopes.

    Therefore, many of the requested bullet points, such as "MRMC comparative effectiveness study," "standalone (i.e. algorithm only) performance," "sample size for training set," and "how ground truth for training set was established," are not applicable to this type of device and are not discussed in the clearance letter.

    The clearance relies heavily on bench testing and biocompatibility data to demonstrate substantial equivalence to a predicate device, rather than clinical study data or AI performance metrics.

    Here's an analysis of the provided text in relation to your questions:

    1. A table of acceptance criteria and the reported device performance

    The document does not present a formal table of acceptance criteria with quantified reported device performance in the precise way you've requested for an AI/SaMD. Instead, it lists the types of performance tests conducted and states that the device "met all design specifications" and "demonstrated safety and essential performance."

    The acceptance criteria are implicitly defined by the standards and the comparison to the predicate device. The performance is summarized as meeting these criteria.

    Acceptance Criteria CategorySpecific Tests/Standards MentionedReported Device Performance (Summary)
    BiocompatibilityISO 10993-1, ISO 10993-5 (Cytotoxicity), ISO 10993-10 (Skin Sensitization, Irritation), ISO 10993-11 (Acute Systemic Toxicity, Pyrogen Test)Evaluation conducted in accordance with FDA guidance and ISO standards. Implicitly, the device passed these tests to demonstrate biocompatibility.
    Sterilization ValidationISO 11135 (EO sterilization), ISO 11737-2 (Tests of sterility), ISO 10993-7 (EO sterilization residuals)EO sterilization validated according to applicable standards. Implicitly, the device maintained sterility and acceptable residuals.
    Shelf Life & Sterile Barrier SystemASTM F1980 (Accelerated Aging), ISO 11607-1 & -2 (Packaging), ASTM F1929 (Seal Leaks by Dye Penetration), ASTM D3078 (Flexible Packaging Leaks by Bubble Emission), DIN 58593-6 (Microbial Barrier Testing), ASTM F88/F88M (Seal Strength), ASTM D4169 (Shipping Containers)Validated according to applicable standards. Implicitly, the device maintained sterility and integrity of the sterile barrier system for the declared shelf life (3 years).
    Performance Data – BenchAppearance, Sizes, Endoscope Compatibility, Operational performance (ISO 8600-1, ISO 8600-4), Safety against tissue damage, Connection reliability, Resistance against endoscope damage in combination assembly with compatible endoscope"Performance tests were implemented on both the subject device and the predicate device to demonstrate substantial equivalence." "All performances including mechanical property and chemical property are verified to confirm the performance of the subject device is substantially equivalent to the predicate device." "Favorable test results demonstrated the subject device's safety on such issue concerns."

    2. Sample sizes used for the test set and the data provenance

    • Sample Size for Test Set: Not explicitly stated in terms of number of devices or number of tests conducted for each category. The document indicates "performance tests were implemented on both the subject device and the predicate device," implying sufficient samples were used to conduct the various bench tests. This is a physical device, so "test set" would refer to the number of physical devices and components tested.
    • Data Provenance: The testing was conducted by Alton (Shanghai) Medical Instruments Co. Ltd. (China). The data origin is from their internal testing. The document implies these are prospective tests conducted specifically for this submission.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

    • N/A. This is a physical non-AI medical device. The "ground truth" for its performance is established through adherence to engineering specifications, material properties, and standardized testing protocols (e.g., ISO, ASTM standards), not through expert consensus on images or clinical outcomes.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    • N/A. Adjudication methods like 2+1 or 3+1 are typically used for establishing ground truth in clinical imaging studies or pathology where human annotators are involved. For this physical device, performance is evaluated against objective, measurable criteria defined by engineering standards and specifications.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    • No. This is a physical device, not an AI/SaMD. MRMC studies are not applicable.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    • N/A. This is a physical device, not an algorithm.

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

    • For this physical device, the "ground truth" (or basis for verification) comes from engineering specifications, material science principles, and international consensus standards (e.g., ISO for biocompatibility and sterilization, ASTM for packaging and mechanical properties). The device's performance is compared against the established limits or requirements of these standards and against the performance of the predicate device.

    8. The sample size for the training set

    • N/A. This is a physical device, not an AI/SaMD. There is no "training set."

    9. How the ground truth for the training set was established

    • N/A. This is a physical device, not an AI/SaMD. There is no "training set" or corresponding ground truth establishment process in the AI sense.
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    K Number
    K241679
    Date Cleared
    2025-03-04

    (266 days)

    Product Code
    Regulation Number
    874.4680
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The cytology brush has been specifically designed to collect specimens or cells endoscopically for cytologic examination in conjunction with bronchoscopes.

    Intended patient population: Adults

    Device Description

    The Disposable Cytology Brush is a sterile, single-use device as a kind of accessories for bronchial endoscopy. The Disposable Cytology Brush is intended to be used in conjunction with a bronchoscope to collect cells from the bronchi.

    The Disposable Cytology Brush is designed to insert through suitable endoscope's accessory channel to collect cells from the bronchi.

    The Disposable Cytology Brush mainly consists of brush head part and handle part. The brush head is composed of bullet, bristles, brush core, brush sheath, connecting tube and steel wire. The handle part is composed of hand grip and push/ pull rod.

    The Disposable Cytology Brush has two different models depending on different design of the brush head. The WB series is a cytology brush with straight type of brush head and the XA series is a cytology brush with oval type of brush head. Each model has different specifications depending on different working length.

    AI/ML Overview

    The provided text is a 510(k) summary for a medical device (Disposable Cytology Brush) and primarily focuses on demonstrating substantial equivalence to a predicate device rather than detailing a study that proves the device meets specific acceptance criteria in the context of an AI/algorithm-based diagnostic product. The document describes a traditional medical device (a cytology brush), not an AI/software device.

    Therefore, many of the requested categories for AI/algorithm performance (e.g., sample size for test set, number of experts, MRMC studies, standalone performance, training set details) are not applicable to this document.

    However, I can extract information related to non-clinical testing performed to demonstrate the device's performance and safety, which serves a similar purpose to meeting acceptance criteria for a physical device.

    Here's the breakdown based on the provided text:

    Device: Disposable Cytology Brush (AF series)

    1. A table of acceptance criteria and the reported device performance:

    The document doesn't present a formal table of "acceptance criteria" with quantitative targets alongside "reported device performance" in the way one would for an AI diagnostic. Instead, it lists performance tests conducted to verify the device meets design specifications and is substantially equivalent to a predicate. The "acceptance criteria" are implied to be "met all design specifications" and "demonstrated safety and essential performance" based on applicable standards. The "reported device performance" is summarized as the tests being successfully performed and demonstrating substantial equivalence.

    Acceptance Criteria (Implied)Reported Device Performance (Summary)
    Biocompatibility in accordance with ISO 10993 standardsAll specified biocompatibility tests (Cytotoxicity, Skin Sensitization, Skin Irritation, Acute Systemic Toxicity, Pyrogen) were performed and validated.
    Sterilization validation (EO sterilization) per ISO 11135EO sterilization validated according to ISO 11135, ISO 11737-2, ISO 10993-7, USP .
    Shelf Life and Sterile Barrier System validationValidated per ASTM F1980, ISO11607-1, ISO11607-2, ASTM F 1929, ASTM D 3078, DIN 58593-6, ASTM F88/F88M-15, ASTM D4169-16.
    Mechanical performance/design specificationsAll specified performance tests (Appearance, Size and Dimension, Bronchoscope Compatibility, Brush Bond Strength, Tensile Strength, Push ability and Actuation, Tissue Sampling Performance) were performed on both subject and predicate devices, demonstrating substantial equivalence.
    Safety and effectiveness (Substantial Equivalence to Predicate)Non-clinical testing demonstrated that differences did not adversely affect performance and the device is substantially equivalent to the legally marketed predicate.

    2. Sample size used for the test set and the data provenance:

    • Sample Size: The document does not specify the exact number of devices/samples used for each non-clinical test (e.g., how many brushes were tested for tensile strength).
    • Data Provenance: The tests are described as "Non-clinical testing for Disposable Cytology Brush." The document's origin (Alton (Shanghai) Medical Instruments Co. Ltd in China) suggests the testing likely occurred there or was managed by them. The studies are bench (laboratory) tests and do not involve patient data in the typical sense of a clinical study.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

    • Not Applicable. This is a physical medical device. Ground truth, in the AI/diagnostic sense, is not established by human experts for these mechanical/biocompatibility tests. The "ground truth" here is compliance with engineering specifications and recognized international standards.

    4. Adjudication method for the test set:

    • Not Applicable. See point 3.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

    • Not Applicable. This is not an AI/imaging device that would involve human readers.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:

    • Not Applicable. This is a physical device, not an algorithm.

    7. The type of ground truth used:

    • For biocompatibility: Adherence to ISO 10993 standards (e.g., no cytotoxicity, no irritation).
    • For sterilization: Adherence to ISO 11135 standards (e.g., Sterility Assurance Level of 10-6).
    • For shelf life/sterile barrier: Adherence to ASTM and ISO 11607 standards (e.g., package integrity, product performance after aging).
    • For mechanical performance: Meeting internal design specifications and demonstrating performance comparable to the predicate device through side-by-side bench testing.

    8. The sample size for the training set:

    • Not Applicable. This is not an AI device that requires a training set.

    9. How the ground truth for the training set was established:

    • Not Applicable. See point 8.

    In summary, this 510(k) pertains to a traditional medical device (a cytology brush) and not an AI or software-driven diagnostic tool. Therefore, the information provided in the document focuses on demonstrating substantial equivalence through non-clinical bench testing, biocompatibility, and sterilization validation, rather than the types of studies typically conducted for AI-powered diagnostic devices.

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    K Number
    K241285
    Date Cleared
    2024-10-01

    (147 days)

    Product Code
    Regulation Number
    876.1500
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Disposable Endoscope Valve Sets is a collection of several sterile units. It is intended to be fitted to multiple endoscope working channels/ports to control the flow of fluids, gases and other materials. It includes an Air/Water Valve, a Suction Valve, a Biopsy Valve and an Auxiliary Water Connector.

    • Air/Water Valve: This unit is intended to be fitted to an endoscope air/water channel to control the inflow of medical gases and water, whilst preventing back-flow.

    • Suction Valve: This unit is intended to be fitted to an endoscope suction channel to control the operations of suction. whilst preventing inflow of air.

    • Biopsy Valve: This unit is intended to be fitted to an endoscope biopsy port to prevent leakage of gases and body fluids during an endoscopic procedure.

    • Auxiliary Water Connector: This unit is intended to provide irrigation via sterile water supply during GI endoscopic procedures when used in conjunction with an irrigation pump.

    Device Description

    The Disposable Endoscope Valves Set is a collection of several sterile units, it is intended for single-use and supplied sterile. The subject device is intended to be fitted to multiple endoscope working channels/ports to control the flow of fluids, gases and other materials. It includes an Air/Water Valve, a Suction Valve, a Biopsy Valve and an Auxiliary Water Connector.

    • The Suction Valve component of the Disposable Endoscope Valves Set is designed to be attached to the suction port of the endoscope, allowing the user to aspirate excess fluids or other debris obscuring the endoscopic image.

    • The Air/Water Valve component of the Disposable Endoscope Valves Set is designed to be attached to the air/ water port of the endoscope, the activation of the air/ water valve allows the user to control air and water flow to assist in cleansing the lens during procedures.

    • The Biopsy Valve component of the Disposable Endoscope Valves Set is intended to cover the endoscope biopsy port during an endoscopy procedure. In addition, the valve provides access for endoscopic device passage and exchange, helps maintain insufflation, and minimizes leakage of biomaterial from the biopsy port throughout the endoscopic procedure.

    • The Auxiliary Water Connector component of the Disposable Endoscope Valves Set is designed to be attached to the auxiliary water port of the endoscopes. The auxiliary water connector consists of a backflow valve that prevents the backflow of water or biomaterials from the endoscope to the sterile water bottle.

    AI/ML Overview

    The provided text is a 510(k) summary for the Disposable Endoscope Valves Set (AF series). It focuses on demonstrating substantial equivalence to a predicate device based on non-clinical performance testing. It does not describe a study involving human-in-the-loop performance, expert readers, or AI assistance for image interpretation. Therefore, many of the requested elements are not applicable to the information contained in this document.

    Here's an analysis based only on the provided text:

    Preamble:
    The document describes a medical device (Disposable Endoscope Valves Set) that physically controls fluids and gases during endoscopic procedures. It is not a device that performs AI-assisted image analysis or requires human interpretation of images for its function. Consequently, specific criteria related to AI performance, human reader studies (MRMC), or a comprehensive test set with ground truth established by experts for diagnostic accuracy are not found in this regulatory submission. The studies described are engineering and performance validation tests for the physical device.


    1. A table of acceptance criteria and the reported device performance

    The document lists performance tests conducted, but does not provide a formal table of acceptance criteria with corresponding performance data. Instead, it states that "Non-clinical testing...was conducted to verify that the subject device met all design specifications, demonstrated safety and essential performance...". The individual tests are listed, implying that the acceptance criterion for each was successful completion.

    Summary of Performance Tests Implemented (Implied Acceptance: "Met All Specifications"):

    Component TestedPerformance Tests ImplementedImplied Acceptance Criteria & Reported Performance
    Suction Valve- Endoscope CompatibilityPassed (met all design specifications)
    - Depression ForcePassed (met all design specifications)
    - Leakage TestPassed (met all design specifications)
    - Suction FlowPassed (met all design specifications)
    Air/Water Valve- Endoscope CompatibilityPassed (met all design specifications)
    - Air flow ratePassed (met all design specifications)
    - Water flow ratePassed (met all design specifications)
    - Leakage TestPassed (met all design specifications)
    - Depression ForcePassed (met all design specifications)
    - Backflow Performance TestPassed (met all design specifications)
    Biopsy Valve- Endoscope CompatibilityPassed (met all design specifications)
    - Leakage TestPassed (met all design specifications)
    Auxiliary Water Connector- Endoscope CompatibilityPassed (met all design specifications)
    - Leakage TestPassed (met all design specifications)
    - Water Flow RatePassed (met all design specifications)
    - Backflow Performance TestPassed (met all design specifications)

    Other Non-Clinical Testing:

    • Biocompatibility: In accordance with ISO 10993 series (MTT Cytotoxicity, Skin Sensitization, Skin Irritation, Acute Systemic Toxicity, Pyrogen Test).
    • Sterilization Validation: In accordance with ISO 11135, ISO 11737-2, ISO 10993-7, USP .
    • Shelf Life and Sterile Barrier System: In accordance with ASTM F1980, ISO11607-1, ISO11607-2, ASTM F 1929, ASTM D 3078, DIN 58593-6, ASTM F88/F88M, ASTM D4169.

    2. Sample size used for the test set and the data provenance

    The document does not specify exact sample sizes for each "bench-A" performance test. It mentions that "performance tests were implemented on both the subject device and the predicate device," implying a comparative, laboratory-based testing approach.

    • Sample Size: Not explicitly stated for each test, but implied to be sufficient for engineering validation.
    • Data Provenance: Laboratory testing, likely conducted by the manufacturer (Alton (Shanghai) Medical Instruments Co. Ltd.) in China, as part of their regulatory submission for the U.S. FDA. The tests are non-clinical, likely prospective validation tests performed on newly manufactured devices.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

    Not applicable. This device is a physical instrument, not an AI or diagnostic imaging device that requires expert-established ground truth from medical images. The "ground truth" for its performance is engineering specifications and physical measurements, not clinical diagnoses.


    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    Not applicable. Adjudication methods like 2+1 or 3+1 are used for establishing ground truth in human reader studies or for training/validating AI models with subjective interpretations (e.g., radiology image interpretation). This document describes the engineering performance validation of a physical device.


    5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    No. An MRMC study is not applicable as this is a physical medical instrument (endoscope valves), not a diagnostic algorithm or AI-assisted interpretation tool. The document explicitly states "N/A, no clinical studies are available for the subject device."


    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    Not applicable. The device is a physical set of valves, not an algorithm.


    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

    Not applicable. The "ground truth" for this device's performance relates to its physical and functional specifications (e.g., flow rates, leakage prevention, depression force, material compatibility, sterility, shelf life). These are established through engineering standards and testing, not clinical outcomes or expert consensus on medical images.


    8. The sample size for the training set

    Not applicable. This device does not involve a "training set" in the context of machine learning or AI.


    9. How the ground truth for the training set was established

    Not applicable. As there is no training set for an AI/ML algorithm, no ground truth was established in this context.

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    K Number
    K231633
    Date Cleared
    2024-01-11

    (220 days)

    Product Code
    Regulation Number
    876.4400
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Disposable Hemoclip is indicated for clip placement within the gastrointestinal (GI) tract for the purpose of:

    1. Endoscopic marking
    2. Hemostasis for:
      • Mucosal/sub-mucosal defects
    Device Description

    The Disposable Hemoclip is the key and common accessory in the diagnosis and treatment procedure of digestive endoscope. As a single use instrument, the disposable hemoclip does not allow to be used by twice, and cannot be separated by components except to be used as well. It is also a sterile device consisting of a pre-loaded, radiopaque, single-use, endoscopic clipping device consisting of two main components: the delivery system and the clip. The delivery system consists of a handle and tube. The delivery system is constructed using stainless steel and polyester materials. The delivery system will allow for the device to rotate at the distal end. The delivery system is offered in 1600mm, 1800mm, 2100mm and 2300mm working lengths.
    The clip is made of stainless-steel material and deployed from the delivery system during use. The clip jaws are designed that they can be opened and closed up to five times prior to deployment, aiding in repositioning of the clip at the lesion site. Re-opening, closing, and rotation capability may be limited by clinical circumstances and patient anatomy.

    AI/ML Overview

    The provided text is a 510(k) Summary for a medical device called "Disposable Hemoclip (AF series)". It describes the device, its intended use, a comparison with a predicate device, and the non-clinical data used to demonstrate substantial equivalence.

    However, the document does not contain information about:

    • A table of acceptance criteria and the reported device performance in the sense of predefined thresholds for clinical efficacy or accuracy. Instead, it lists various non-clinical tests performed.
    • Sample sizes used for a "test set" in a clinical study because no clinical studies were performed.
    • Data provenance, number of experts, adjudication methods, or MRMC studies, as these relate to clinical data which is explicitly stated as N/A.
    • Standalone algorithm performance or details about ground truth for training data, as this is a physical medical device, not an AI/software device.

    Therefore, many of the requested items cannot be provided from the given input.

    Here's a breakdown of what can be extracted based on the provided text:

    1. Table of Acceptance Criteria and Reported Device Performance

    The document does not present "acceptance criteria" in the format of specific thresholds for clinical performance (e.g., sensitivity, specificity, accuracy) because it relies on non-clinical testing for substantial equivalence. Instead, it lists various non-clinical tests performed to demonstrate that the subject device performs similarly to the predicate device. The "reported device performance" is essentially that the device "met all design specifications" and that "test results demonstrate substantial equivalence between the subject device and the predicate device" for each test.

    Test ItemAcceptance Criteria (Implied)Reported Device Performance
    BiocompatibilityCompliance with FDA guidance "Use of International Standard ISO 10993-1, 'Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process'" September 4, 2020, and ISO 10993-1. Specific tests for cytotoxicity, sensitization, systemic toxicity (acute, subacute, subchronic), pyrogenicity, genotoxicity, and local effects after implantation.All specified tests (MTT Cytotoxicity, Skin Sensitization, Intracutaneous, Acute Systemic Toxicity, Subacute Systemic Toxicity, Subchronic Systemic Toxicity, Pyrogen, Genotoxicity, Muscle Implant) were considered and passed according to the relevant ISO 10993 standards.
    Sterilization ValidationCompliance with ISO 11135:2014+A1:2018 (EO sterilization), ISO 11737-2:2019 (sterility tests), ISO 10993-7:2008 (EO residuals), and USP (bacterial endotoxins).Validated according to applicable standards.
    Shelf Life & Sterile BarrierCompliance with ASTM F1980-16 (accelerated aging), ISO11607-1:2019 (materials/systems), ISO11607-2:2019 (validation of process), ASTM F 1929-15 (dye penetration), ASTM D 3078-02(2013) (bubble emission), DIN 58593-6: 2016 (microbial barrier), ASTM F88/F88M-15 (seal strength), ASTM D4169-16 (shipping performance).Validated according to applicable standards.
    Mechanical PerformancePerformance consistent with the specific product technical specification and demonstrating substantial equivalence to the predicate device.Tests for Surface roughness/hardness, Clip Assembly Repeated Open/Close, Clip Retention Force, Clip Releasing Force, 360° Rotation, Clip Close Force, Clamp strength-durability, Clamp strength-stability, Separation Force, Clip approach, Metal Part Against Corrosion were performed. The test results "demonstrate substantial equivalence between the subject device and the predicate device."

    2. Sample size used for the test set and the data provenance

    • Test Set Sample Size: Not applicable. The submission relies on non-clinical (bench) testing, not clinical studies with patients or human data to form a "test set" in the context of clinical performance.
    • Data Provenance: The non-clinical tests were conducted internally or by contract labs following recognized standards.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

    • Not applicable. No clinical studies were conducted, and therefore no ground truth was established by medical experts for a test set.

    4. Adjudication method for the test set

    • Not applicable. No clinical studies requiring adjudication were performed.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    • Not applicable. This is a physical medical device (hemoclip), not an AI/software device, and no MRMC studies were performed.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    • Not applicable. This is a physical medical device, not an algorithm.

    7. The type of ground truth used

    • The "ground truth" for the non-clinical tests was established by adhering to recognized international and FDA standards (e.g., ISO, ASTM, USP) for biocompatibility, sterilization, shelf life, and mechanical properties. The performance of the predicate device also served as a benchmark for demonstrating substantial equivalence.

    8. The sample size for the training set

    • Not applicable. This is a physical medical device, not an AI/software device that requires a training set.

    9. How the ground truth for the training set was established

    • Not applicable, for the same reason as above.
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    K Number
    K230925
    Date Cleared
    2023-09-27

    (177 days)

    Product Code
    Regulation Number
    876.1500
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    Alton (Shanghai) Medical Instruments Co. Ltd

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Disposable Injection Needle is intended to be used in conjunction with an endoscope to perform endoscopic injections, such as for the treatment of esophageal and gastric varies and for submucosal dye marking in the GI tract.

    Device Description

    The Disposable Injection Needle is a sterile, single-use device as a kind of accessories for digestive endoscopy. The Disposable Injection Needle is intended to be used in conjunction with an endoscope to perform endoscopic injections, such as for the treatment of esophageal and gastric varies and for submucosal dye marking in the GI tract.

    The Disposable Injection Needle is designed to insert through the suitable endoscope's forceps to inject harden agent to target lesion in treatment for bleeding of esopha-gastric varix or to mark the lesions of the digestive tract.

    The Disposable Injection Needle has different model specifications depending on different working length and the needle size.

    AI/ML Overview

    This document is a 510(k) summary for a Disposable Injection Needle. It focuses on demonstrating substantial equivalence to a predicate device rather than presenting a study proving that the device meets specific acceptance criteria for a complex AI/software-driven medical device. Therefore, the requested information, which pertains to such a study (sample sizes, expert adjudication, MRMC studies, ground truth establishment for AI/ML models), is not present in the provided text.

    The document discusses non-clinical bench testing to demonstrate that the Disposable Injection Needle meets design specifications and performs comparably to a predicate device. This is a physical device, not an AI/ML-driven one.

    Here's an analysis of the provided text in relation to your request:

    1. A table of acceptance criteria and the reported device performance:

    The document doesn't provide a direct "acceptance criteria" table in the sense of performance metrics for an AI/ML model (e.g., sensitivity, specificity, AUC). Instead, it lists various physical and chemical performance tests for the medical device. The "acceptance criteria" for these tests would be meeting the specified thresholds or demonstrating equivalence to the predicate device. The "reported device performance" is that the tests were carried out and demonstrated substantial equivalence.

    Non-Clinical Performance Tests Performed:

    Test CategorySpecific Tests PerformedReported Performance
    Material/Device SafetyBiocompatibility (Cytotoxicity, Skin Sensitization, Skin Irritation, Acute/Subacute Systemic Toxicity, Pyrogen Test)Complies with ISO 10993 standards and FDA guidance.
    SterilizationEO sterilization validation (ISO 11135, ISO 11737-2, ISO 10993-7, USP )Validated according to applicable standards.
    Shelf Life & PackagingAccelerated Aging (ASTM F1980), Packaging Requirements (ISO11607-1, ISO11607-2), Seal Leaks (ASTM F 1929, ASTM D 3078), Microbial Barrier (DIN 58593-6), Seal Strength (ASTM F88/F88M), Shipping Performance (ASTM D4169)Validated according to applicable standards.
    Bench PerformanceAppearance, Dimension, Bond Strength, Operational performance, Puncture Performance, Liquid leakage, Injection connector (Luer connector), Patency of lumen, Corrosion Property, Chemical performanceTests carried out, demonstrated substantial equivalence to predicate.

    2. Sample size used for the test set and the data provenance:

    • Sample Size: Not explicitly stated for specific tests. The document mentions tests were performed on "both the subject device (Alton Disposable Injection Needle) and the predicate device (Anrei Single Use Injection Needle)." It doesn't specify the number of units tested for each.
    • Data Provenance: Not applicable in the context of clinical or image data. The "data" here refers to the results of bench testing. There is no mention of country of origin of data, nor whether it's retrospective or prospective, as these terms apply to clinical studies.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience):

    Not applicable. This device is a physical medical instrument, not an AI/ML system that requires expert annotation for ground truth. The "ground truth" for these tests would be established by validated test methods and reference standards.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

    Not applicable. This is not a study involving human readers or interpretation.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

    Not applicable. This is not an AI-assisted device. The document explicitly states: "N/A, no clinical studies are available for the subject device."

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:

    Not applicable. This is not an algorithm.

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc):

    The ground truth for this device's performance is based on established engineering and materials testing standards (e.g., ISO, ASTM, USP) and the performance of the legally marketed predicate device. For example, for biocompatibility, the ground truth is compliance with ISO 10993. For mechanical performance, it's demonstrating equivalence to the predicate and meeting specified functional requirements.

    8. The sample size for the training set:

    Not applicable. This is not an AI/ML device that requires a training set.

    9. How the ground truth for the training set was established:

    Not applicable.

    In summary: The provided FDA 510(k) summary is for a physical medical device (Disposable Injection Needle) and demonstrates substantial equivalence through non-clinical bench testing against a predicate device and adherence to recognized standards. It does not contain the information requested regarding AI/ML device performance studies, as those types of studies (MRMC, standalone algorithm performance, expert adjudication, ground truth for training/test sets) are not relevant to this specific device submission.

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