LIFESTENT LP SDS BILIARY ENDOPROSTHESIS

K023248 · Orbus Medical Technologies · FGE · Feb 11, 2003 · Gastroenterology, Urology

Device Facts

• Record ID: K023248
• Device Name: LIFESTENT LP SDS BILIARY ENDOPROSTHESIS
• Applicant: Orbus Medical Technologies
• Product Code: FGE · Gastroenterology, Urology
• Decision Date: Feb 11, 2003
• Decision: SESU
• Submission Type: Traditional
• Regulation: 21 CFR 876.5010
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The LifeStent LP SDS Biliary Endoprosthesis is intended for the palliation of malieriant neoplasms in the biliary tree.

Device Story

LifeStent LP SDS Biliary Endoprosthesis is a balloon-expandable stent system used to maintain patency of bile ducts obstructed by malignant tumors. The device consists of a laser-cut 316L stainless steel stent mounted on a percutaneous transluminal angioplasty (PTA) balloon catheter. During a clinical procedure, a physician inserts the system percutaneously to the diseased site and expands the stent via balloon inflation. The stent remains permanently implanted to provide structural support. The device is intended for use in the biliary tree; it is not indicated for vascular use.

Clinical Evidence

Bench testing only. Protocols evaluated deployment, expansion force, compression force, dimensions, corrosion susceptibility, visual appearance, balloon performance, expansion damage, and balloon tensile strength to demonstrate substantial equivalence to predicate devices.

Technological Characteristics

Balloon-expandable stent made of 316L stainless steel; laser-cut open lattice design. Supplied mounted on a PTA balloon catheter. Available in 4.0, 5.0, 6.0 mm diameters and 18, 36, 56 mm lengths. Sterilization and packaging methods are consistent with predicate devices.

Indications for Use

Indicated for the palliation of malignant neoplasms in the biliary tree.

Regulatory Classification

Identification

A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic type of device may include a bile collecting bag that is attached to the biliary catheter by a connector and fastened to the patient with a strap.

Special Controls

*Classification.* Class II (special controls). The device, when it is a bile collecting bag or a surgical biliary catheter that does not include a balloon component, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

Predicate Devices

• IntraStent DoubleStrut ParaMount XS Biliary Endoprosthesis
• PALMAZ CORINTHIAN Transhepatic Biliary Stent and Delivery System
• PALMAZ GENESIS Transhepatic Biliary Stent on SLALOM .018" Delivery System
• OTW MEGALINK SDS Biliary Stent System

Reference Devices

• Ultraverse catheter (K964881, K010169, K012913)

Submission Summary (Full Text)

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FEB 1 1 2003

ge 1 of 2

Image /page/0/Picture/2 description: The image shows the logo for ORBUS MEDICAL TECHNOLOGIES INC. The logo consists of a stylized eye symbol on the left, followed by the word "ORBUS" in a bold, sans-serif font. Below "ORBUS" is the text "MEDICAL TECHNOLOGIES INC." in a smaller, sans-serif font, with a line separating it from the word "ORBUS" above.

CORPORATE NW 35 FORT LAUDERDALE FI ORIDA 33309 954/730-0711 954/730-7601 ww.orgusmt.com

# XIII: 510(k) SUMMARY

| 1. Submitter: | Orbus Medical Technologies, Inc<br>5363 NW 35th Ave<br>Fort Lauderdale, Florida 33309<br>Phone: [phone]<br>Fax: [phone] |
|---------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 2. Contact: | Jim Clossick<br>Director of Quality Assurance and Regulatory Affairs |
| 3. Date Prepared: | September 27, 2002 |
| 4. Device Trade Name: | LifeStent LP SDS Biliary Endoprosthesis |
| 5. Device Common Name: | Biliary stent |
| 6. Device Classification: | Biliary Catheter (78 FGE) |
| 7. Predicate Devices: | IntraStent DoubleStrut ParaMount XS Biliary Endoprosthesis<br>PALMAZ CORINTHIAN Transhepatic Biliary Stent and Delivery<br>System<br>PALMAZ GENESIS Transhepatic Biliary Stent on SLALOM .018"<br>Delivery System<br>OTW MEGALINK SDS Biliary Stent System |

#### 8. Description:

The LifeStent LP SDS Biliary Endoprosthesis consists of a balloon expandable stent which is provided mounted onto a percutaneous transluminal angioplasty (PTA) balloon catheter which acts as the delivery system. The stent is a permanently implanted device used to maintain patency of a major bile duct obstructed by tissue of an impinging tumor. This flexible, balloon expandable stent is made by laser cutting an open lattice design into a 316L stainless steel tube. The stent is supplied mounted onto a PTA balloon catheter, inserted percutaneously to the diseased site, and expanded by balloon inflation. The systems are available with expanded diameters of 4.0, 5.0, 6.0 mm at stent lengths of 18, 36, and 56 mm.

### 9. Intended Use:

The LifeStent LP SDS Biliary Endoprosthesis is intended for the palliation of malieriant neoplasms in the biliary tree.

### 10. Technological Characteristics:

Comparisons of the new and predicate devices were designed to show that the technical characteristics such as materials, performance properties, biocompatibility, method of sterilization, and packaging are identical or substantially equivalent.

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## 11. Performance Data:

Orbus protocols ensure that the LifeStent LP SDS Biliary Endoprosthesis performs in a manner substantially equivalent to the predicate devices during in vitro tests such as deployment, expansion force, compression force, dimensions, corrosion susceptibility, visual appearance, balloon performance, expansion damage, and balloon tensile strength.

### 12. Conclusion

Since the LifeStent LP SDS Biliary Endoprosthesis, comprised of the Ø 4-7 mm LifeStent and the Ultraverse catheter (K964881, K010169, K012913), has the same intended use, identical material properties, similar performance properties, packaging, and sterilization methods, it may be considered substantially equivalent to the predicate devices cited in (7).

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Image /page/2/Picture/1 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 an abstract symbol that resembles a stylized caduceus or a representation of the human form, with three wavy lines forming the body and head.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 1 1 2003

Mr. Jim Clossick Director of Quality Assurance and Regulatory Affairs Orbus Medical Technologies 5363 NW 35th Avenue FORT LAUDERDALE FL 33309

Re: K023248

Trade/Device Name: Lifestent™ LP SDS Biliary Endoprosthesis Regulation Number: 21 CFR §876.5010 Regulation Name: Biliary catheter and accessories Regulatory Class: II Product Code: 78 FGE Dated: January 16, 2003 Received: January 17, 2003

Dear Mr. Clossick:

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). You may, therefore, market the device, subject to the general controls provisions of the Act and the limitations described below. 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.

The Office of Device Evaluation has determined that there is a reasonable likelihood that this device will be used for an intended use not identified in the proposed labeling and that such use could cause harm. Therefore, in accordance with Section 513(i)(1)(E) of the Act, the following limitation must appear in the Warnings section of the device's labeling:

The safety and effectiveness of this device for use in the vascular system have not been established.

Furthermore, the indication for biliary use must be prominently displayed in all labeling, including pouch, box, and carton labels, instructions for use, and other promotional materials, in close proximity to the trade name, of a similar point size, and in bold print.

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Page 2 - Mr. Jim Clossick

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 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); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and permits your device to proceed to the market. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification if the limitation statement described above is added to your labeling.

Please note that the above labeling limitations are required by Section 513(i)(1)(E) of the Act. Therefore, a new 510(k) is required before these limitations are modified in any way or removed from the device's labeling.

If you desire specific information about the application of other labeling requirements to your device (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21 CFR Part 807.97). 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/cdrh/dsma/dsmamain.html.

Sincerely yours,

Daniel G. Schultz, M.D. Director Office of Device Evaluation Center for Devices and Radiological Health

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Page__________________________________________________________________________________________________________________________________________________________________________

510(k) Number (if known):_K023248

Device Name: Orbus LifeStent LP SDS Biliary Endoprosthesis

FDA's Statement of the Indications For Use for device:

The Orbus LifeStent LP SDS Biliary Endoprosthesis is indicated for use for the palliation of malignant neoplasms in the biliary tree.

| Perscription Use<br>(Per 21 CFR 801.109) | OR | Over-the-Counter Use |
|------------------------------------------|----|----------------------|
|------------------------------------------|----|----------------------|

Nancy C Brogdon
(Division Sign-Off)
Division of Reproductive, Abdominal,
and Radiological Devices

| 510(k) Number | K023248 |
|---------------|---------|
|---------------|---------|