DISPOSABLE BENDING CANNULA PR-233Q

K011149 · The Olympus Optical Co. · ODD · May 15, 2001 · Gastroenterology, Urology

Device Facts

• Record ID: K011149
• Device Name: DISPOSABLE BENDING CANNULA PR-233Q
• Applicant: The Olympus Optical Co.
• Product Code: ODD · Gastroenterology, Urology
• Decision Date: May 15, 2001
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.1500
• Device Class: Class 2

Intended Use

The subject device, DISPOSABLE BENDING CANNULA PR-233Q has been designed to be used with an Olympus endoscope to inject contrast medium in the biliary and pancreatic ducts, although it is not designed for the deep insertion into the pancreatic duct.

Device Story

Disposable bending cannula PR-233Q; used with Olympus endoscope; facilitates injection of contrast medium into biliary and pancreatic ducts. Features bending function via angle wire; allows manipulation in two directions; assists insertion into ducts. Used by clinicians in clinical settings. Device provides mechanical access for contrast delivery; improves ease of ductal navigation compared to standard cannulas. Not intended for deep pancreatic duct insertion.

Clinical Evidence

Bench testing only.

Technological Characteristics

Disposable cannula with integrated bending function (angle wire) for two-directional manipulation. Designed for use with Olympus endoscopes. Materials and design consistent with predicate devices.

Indications for Use

Indicated for use with an Olympus endoscope to inject contrast medium into the biliary and pancreatic ducts. Not indicated for deep insertion into the pancreatic duct.

Regulatory Classification

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.

Special Controls

*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.

Predicate Devices

• PR-23Q DISPOSABLE BALL TIP CANNULA (K950729)
• KD-6G WIRE GUIDED PAPILLOTOMY KNIVES (K950166)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle or bird-like symbol. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the bird symbol.

#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

Olympus Optical Co., LTD % Ms. Laura Storms-Tyler Director, Regulatory Affairs and Quality Assurance Olympus America, Inc. Two Corporate Center Drive Melville, NY 11747-3157

·JUL 2 7 2015

K011149 Re: Trade/Device Name: DISPOSABLE BENDING CANNULA PR-233Q Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: ODD, FGE Dated (Date on orig SE ltr): March 19, 2001 Received (Date on orig SE Itr): April 16, 2001

Dear Ms. Storms-Tyler,

ﺃ

This letter corrects our substantially equivalent letter of May 15, 2001.

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate 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) that do not require approval of a premarket approval application (PMA). 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be

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found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Benjamin R. Fisher -S

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) Number(if known): ___ Not assigned vet_________________________________________________________________________________________________________________________________ 010(L) Name: _________________________________________________________________________________________________________________________________________________________________

Indications for Use:

This instrument has been designed to be used with an Olympus endoscope I mis instrument mas count in the biliary and pancreatic ducts, although it is not designed for the deep insertion into the pancreatic duct.

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

Concurrence of CDRH, Office of Device Evaluation (ODE) Over-The-Counter Use_ OR ı Prescription Use_ (Per 21 CFR 801.199) (Optoinal Format 1-2-96) Division Sion-Off Division of Reproductive, Abdominal, ENT, and Radiological Devices

510(k) Number K011149

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## MAY 1 5 2001

Kaiii49

### SMDA 510(k) SUMMARY

# DISPOSABLE BENDING CANNULA PR-233Q

## A. Submitter's Name, Address, Phone and Fax Numbers

Name & Address of manufacturer:

2-3-1 Shinjuku Monolis Nishi-Shinjuku, Shinjuku-ku Tokyo, Tokyo 163-0914 Japan 8010047 Registration No .: Address, Phone and Fax Numbers: 2951 Ishikawa-Cho, Hachioji-shi, Tokyo 192-8507 Of R&D Division, Japan Endoscope Group TEL [phone] FAX [phone]

#### B. Name of Contact Person

:: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : ﻟﻠﻘﻀﺎﺀ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻟﻤﺘﺤﺪ

... .

Name: Address, Phone and Fax Numbers: Laura Storms-Tyler Olympus America Inc. Two Corporate Center Drive Melville, New York 11747-3157 TEL: [phone] FAX: [phone]

Olympus Optical Co., Ltd.

# C. Device Name, Common Name, Classification Name and Predicate Devices

| Trade Name: | Disposable Bending Cannula PR-233Q |
|-------------------|--------------------------------------------------------------------------------------------------|
| Common Name: | Disposable Cannula |
| Classification: | 21 CFR 876.1500 Endoscope and accessories<br>21 CFR 876.5010 Biliary catheter and accessories |
| Predicate Device: | PR-23Q DISPOSABLE BALL TIP CANNULA<br>K950729<br>KD-6G WIRE GUIDED PAPILLOTOMY KNIVES<br>K950166 |

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#### D. Description of the Device(s)

The subject device is a cannula which has a bending function (angle wire), to be used in accordance with Intended Use of the Device. This bending function enables the subject device to be manipulated in 2 directions and leads to easier insertion into the biliary and pancreatic ducts.

#### E. Intended Use of the Device(s)

:: :::

The subject device, DISPOSABLE BENDING CANNULA PR-233Q has been designed to be used with an Olympus endoscope to inject contrast medium in the biliary and pancreatic ducts, although it is not designed for the deep insertion into the pancreatic duct.

# F. Summary including Conclusions drawn from Non-clinical Tests

When compared to the predicate device, this subject device Disposable bending cannula PR-233Q does not incorporate any significant changes in the intended use, method of operation, material, or design that could affect the safety or effectiveness.