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The disposable Overtube is a device used in conjunction with a flexible endoscope for foreign body or tissue retrieval and/or for endoscopic re-intubations.

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This is an FDA 510(k) clearance letter for the "Disposable Overtube" (K040836). This type of submission focuses on demonstrating substantial equivalence to a predicate device, rather than providing extensive clinical study data with detailed acceptance criteria as would be found in a PMA (Pre-Market Approval) application or a more recent 510(k) submission that includes performance studies.

Therefore, the provided text does not contain the requested information regarding acceptance criteria, study details, sample sizes, ground truth establishment, or expert qualifications. The letter confirms the device's substantial equivalence to a legally marketed predicate device based on its intended use for foreign body or tissue retrieval and/or for endoscopic intubations in conjunction with a flexible endoscope.

To address the prompt fully, if this were a typical AI/ML medical device submission, the requested information would be found in detailed performance studies within the 510(k) summary or a separate clinical study report. Since that information is absent in the provided document, I cannot populate the table or answer the specific questions.

However, I can extract the following limited information from the provided document:

• Device Name: Disposable Overtube
• Regulation Number: 21 CFR §876.1500
• Regulation Name: Endoscope and accessories
• Regulatory Class: II
• Product Code: 78 KOG
• Indications for Use: The disposable Overtube is a device used in conjunction with a flexible endoscope for foreign body or tissue retrieval and/or for endoscopic intubations.

Without a detailed clinical or performance study report included in the 510(k) summary, which is not part of this clearance letter, I cannot provide the specific information requested about acceptance criteria, study design, or ground truth.

If this were a document that contained such information, the output would be structured as follows (but is currently unfillable from the provided text):

1. Table of Acceptance Criteria and Reported Device Performance

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

• Test Set Sample Size: [Not provided in document]
• Data Provenance: [Not provided in document] (e.g., country of origin, retrospective/prospective)

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

• Number of Experts: [Not provided in document]
• Qualifications of Experts: [Not provided in document]

4. Adjudication method for the test set

• Adjudication Method: [Not provided in document]

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

• MRMC Study Done? [Not provided in document]
• Effect Size (human readers with AI vs. without AI): [Not applicable/Not provided in document for a non-AI device]

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

• Standalone Study Done? [Not applicable for this device as it's not an AI/ML algorithm]

7. The type of ground truth used

• Ground Truth Type: [Not provided in document; typically clinical outcomes, pathology, expert consensus for imaging devices]

8. The sample size for the training set

• Training Set Sample Size: [Not applicable for this type of device submission, as it's not an AI/ML algorithm relying on a training set]

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

• Ground Truth Establishment (Training Set): [Not applicable for this type of device submission]

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