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510(k) Data Aggregation

    K Number
    K990687
    Date Cleared
    1999-03-26

    (25 days)

    Product Code
    Regulation Number
    876.4400
    Reference & Predicate Devices
    Predicate For
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    Olympus HX-5/6-1 Endoscopic Clip Fixing Device has been designed for endoscopic clip placement within the gastrointestinal (GI) tract for the purpose of endoscopic marking, hemostasis in the upper GI tract for mucosal/submucosal defects <3cm, bleeding ulcers and arteries <2mm, polyps<1.5cm in diameter, and anchoring to affix jejunal feeding tubes to the wall of the small bowel. This device is not intended for the repair of GI tract lumenal perforations.

    Device Description

    The HX-5/6-1 Endoscopic Clipping Device is available as a set consisting of the HX-5/6-1 Endoscopic Clipping Device main body and clips. These clips are attached to the hook when the wire is advanced out of the distal end of the device. Applying tension to the control wire will "seat" a step on the clip onto the distal end of the stainless steel coil. The FEP tube sheath may then be advanced to cover the distal end of the coil and the attached clip. The device may then be inserted through the instrument channel of the appropriate endoscope. When the device has been advanced to the area of interest, the tube sheath is retracted by moving the tube joint distally until an audible "click" is heard. When the control section slider is pulled proximally, the control wire is tensioned, and the clip is pulled into the clip body (pipe). Due to the shape of the clip itself, when the clip is pulled into the clip pipe, it will initially open wider. As it is pulled in even further, the clip pipe will force the clip arms to close on the target tissue and deploy.

    AI/ML Overview

    The provided document (K990687) is a 510(k) summary for the Olympus HX-5/6-1 Endoscopic Clipping Device. It primarily focuses on demonstrating substantial equivalence to a predicate device and specifying the intended use, rather than detailing a study with specific acceptance criteria and performance metrics.

    Therefore, many of the requested sections (e.g., sample size for test/training sets, expert qualifications, adjudication methods, MRMC studies, specific ground truth types) are not available in this type of regulatory submission. This document does not describe a study to prove the device meets acceptance criteria in the way a clinical trial report would. Instead, it describes the device and its intended use, and asserts its substantial equivalence to a previously cleared device.

    However, I can extract information related to the device's functional description and intended use, which inherently defines some performance expectations.

    Here's a breakdown of the available information:

    1. Table of Acceptance Criteria and Reported Device Performance

    Note: The document does not explicitly state "acceptance criteria" in a quantitative, measurable sense. The "performance" described is largely functional and mechanical, demonstrating how the device operates and what it is designed to achieve in clinical use. The "criteria" are inferred from the device's intended use and design description, and the "performance" is a description of its operational mechanics.

    Acceptance Criteria (Inferred from Intended Use/Function)Reported Device Performance (Description of Operation)
    Clip Deployment Mechanism:Clips are attached to a hook on the wire. Applying tension to the control wire "seats" a step on the clip onto the distal end of the stainless steel coil. The FEP tube sheath is advanced to cover the coil and attached clip. The device is inserted through the endoscope channel.
    Clip Retraction and Closure:Tube sheath is retracted by moving the tube joint distally until an audible "click." When the control section slider is pulled proximally, the control wire is tensioned, and the clip is pulled into the clip body (pipe).
    Clip Opening and Closing Dynamics:Due to the clip's shape, it initially opens wider as it is pulled into the pipe. As it is pulled further, the clip pipe forces the clip arms to close on the target tissue and deploy.
    Intended Use - Endoscopic Marking:Designed for endoscopic clip placement within the GI tract for endoscopic marking.
    Intended Use - Hemostasis (Upper GI Mucosal/Submucosal Defects):Designed for hemostasis in the upper GI tract for mucosal/submucosal defects <3cm.
    Intended Use - Hemostasis (Bleeding Ulcers and Arteries):Designed for hemostasis for bleeding ulcers and arteries <2mm.
    Intended Use - Hemostasis (Polyps):Designed for hemostasis for polyps <1.5cm in diameter.
    Intended Use - Anchoring (Jejunal Feeding Tubes):Designed for anchoring to affix jejunal feeding tubes to the wall of the small bowel.
    Exclusion of GI Tract Repair:Not intended for the repair of GI tract lumenal perforations. (This is a negative criterion, indicating a limitation.)

    2. Sample Size Used for the Test Set and Data Provenance

    • Sample Size for Test Set: Not specified. This document does not detail a study involving a test set of data or subjects.
    • Data Provenance: Not applicable, as no external data set or study is described in this summary. The information pertains to the device's design and intended function.

    3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

    • Number of Experts: Not applicable. Ground truth establishment for a test set is not described.

    4. Adjudication Method for the Test Set

    • Adjudication Method: Not applicable. No test set or ground truth adjudication process is mentioned.

    5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study was Done

    • MRMC Study: No. The document does not describe a comparative effectiveness study involving human readers with or without AI assistance. The device is a mechanical clipping device, not an AI-assisted diagnostic tool.

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

    • Standalone Study: No. This is a medical device, not an algorithm, so this concept is not applicable. The device is designed for human-in-the-loop operation by a clinician performing an endoscopic procedure.

    7. The Type of Ground Truth Used

    • Type of Ground Truth: Not applicable. The document is not about evaluating a diagnostic algorithm against a ground truth. Its purpose is to demonstrate substantial equivalence of a physical medical device. The "ground truth" here is implied by the clinical context in which such clipping devices are used, as established by medical practice and guidelines for endoscopic hemostasis and marking.

    8. The Sample Size for the Training Set

    • Sample Size for Training Set: Not applicable. This concept applies to machine learning algorithms, not a physical medical device like an endoscopic clipper.

    9. How the Ground Truth for the Training Set Was Established

    • Ground Truth Establishment for Training Set: Not applicable, as there is no training set for this type of device.

    In summary: The provided 510(k) summary (K990687) is a regulatory filing for an endoscopic clipping device, not a report of a study involving clinical data, AI algorithms, or a detailed breakdown of acceptance criteria and performance against those criteria. It describes the device's design, intended use, and asserts its substantial equivalence to a predicate device already on the market.

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