EC-3870CILK, CONFOCAL VIDEO COLONOSCOPE

K042741 · Pentax Medical Company · GCJ · Oct 19, 2004 · Gastroenterology, Urology

Device Facts

• Record ID: K042741
• Device Name: EC-3870CILK, CONFOCAL VIDEO COLONOSCOPE
• Applicant: Pentax Medical Company
• Product Code: GCJ · Gastroenterology, Urology
• Decision Date: Oct 19, 2004
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric, 3rd-Party Reviewed

Indications for Use

The EC-3870CILK, Confocal Video Colonoscope, is intended to provide optical visualization (via a video monitor), (confocal) microscopic visualization of (via a video monitor), and therapeutic access to, the Lower Gastrointestinal Tract. The Lower Gastrointestinal Tract includes, but is not restricted to, the organs; tissues; and subsystems: Large Bowel. The instrument is introduced per rectally when indications consistent with the requirement for the procedure are observed in adult and pediatric patient populations.

Device Story

EC-3870CILK is a confocal video colonoscope used for lower GI tract visualization and therapy. Device inputs include white light for standard endoscopic imaging via CCD and laser light for confocal microscopic imaging via an integrated optical fiber scanner. The endoscope connects to a Pentax Video Processor and a Confocal Laser System. The system computer processes confocal signals, controls the laser source, and stores still images. Operated by physicians in clinical settings, the device provides real-time video and microscopic images on monitors. The confocal capability allows for high-resolution tissue visualization, aiding clinical decision-making during endoscopic procedures. The device includes a working channel for endoscopic accessories, such as biopsy forceps, facilitating therapeutic interventions.

Clinical Evidence

No clinical data. Substantial equivalence determination based on bench testing and comparison of specifications.

Technological Characteristics

Flexible video colonoscope with integrated confocal laser scanning module. Features: CCD for video, optical fiber for laser transmission, working channel for accessories. Connectivity: PVE connector for video processor; confocal electrical connector for laser system. Energy: white light (processor) and laser light (confocal system). Immersible for cleaning.

Indications for Use

Indicated for optical and confocal microscopic visualization and therapeutic access to the lower gastrointestinal tract, including the large bowel, in adult and pediatric patients requiring such procedures.

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

• EC-3800L, Video Colonoscope (K951574)
• Zeiss CLSO Confocal Laser Scanner Ophthalmoscope (K912581)

Submission Summary (Full Text)

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DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Food and Drug Administration
10903 New Hampshire Avenue
Document Control Center - WO66-G609
Silver Spring, MD 20993-0002

Pentax Medical Company
% Mr. Tamas Borsai
Division Manager, Medical Division, and
Program Manager, Third Party Review Program
TÜV Rheinland of North America
12 Commerce Road
Newtown, CT 06470

JUL 27 2015

Re: K042741
Trade/Device Name: EC-3870CILK, Confocal Video Colonoscope
Regulation Number: 21 CFR 876.1500
Regulation Name: Endoscope and accessories
Regulatory Class: II
Product Code: GCJ, FDF
Dated (Date on orig SE ltr): September 30, 2004
Received (Date on orig SE ltr): October 4, 2004

Dear Mr. Borsai,

This letter corrects our substantially equivalent letter of October 19, 2004.

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): ___________________________
Device Name: EC-3870CILK, Confocal Video Colonoscope
Page 1 of 1

## Intended Use Statement:

The EC-3870CILK, Confocal Video Colonoscope, is intended to provide optical visualization (via a video monitor), (confocal) microscopic visualization of (via a video monitor), and therapeutic access to, the Lower Gastrointestinal Tract. The Lower Gastrointestinal Tract includes, but is not restricted to, the organs; tissues; and subsystems: Large Bowel. The instrument is introduced per rectally when indications consistent with the requirement for the procedure are observed in adult and pediatric patient populations.

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

Miriam C. Provost
*(Division Sign-Off)*
Division of General, Restorative, and Neurological Devices

510(k) Number K042741

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K042741 1/1

OCT 19 2004

510(k)Summary

EC-3870C1LK, Confocal Video Colonoscope

Submitter Information:
Pentax Medical Company
102 Chestnut Ridge Road
Montvale, New Jersey 07645-1856
Tel: [phone]

Name Of Device:
| Trade Name: | EC-3870C1LK, Confocal Video Colonoscope |
| --- | --- |
| Classification Name: | Colonoscope, Gastro- Urology (78FDF) {876.1500} [Class II] |

Predicated Device(s) Information:
| Model, Description | Manufacturer | PMN# |
| --- | --- | --- |
| EC-3800L, Video Colonoscope | Pentax Corporation | K951574 |
| Zeiss CLSO Confocal Laser Scanner Ophthalmoscope | Carl Zeiss, Inc. | K912581 |

Device Description:
The EC-3870C1LK, Confocal Video Colonoscope, must be used with a Pentax Video Processor (software controlled device) and with Pentax Confocal Laser System (software controlled device). The endoscope has a Flexible Insertion Tube, a Control Body, PVE Umbilical Connector, and Confocal Electrical Connector. The PVE Connector connects to the Video Processor and has connections for illumination, video signals, air/water and suction. The Control Body includes controls for up/ down/ left/ right angulation, air/water delivery, suction selection/ control, and an accessory inlet port. The device contains light carrying bundles to illuminate the body cavity, a charge couple device (CCD) to collect image data, forward water jet tube, and a confocal scanner. The instrument contains a working channel through legally marketed endoscopic accessories may be introduced (the instrument is supplied with two biopsy forceps). The Video Processor contains a lamp that provides white light and is focused at the PVE Connector Lightguide Prong. The endoscope light carrying bundles present the light to the body cavity and the CCD collects color image data. Image data and other screen display information are formatted and presented to the video outputs of the Video Processor for display on the endoscopic image monitor. The endoscope confocal scanner contains an optical fiber that transmits laser light to, and receives return light from, the subject tissue. The confocal electrical connector is connected to the confocal laser system. The confocal laser system contains a laser light source which produces visible laser light and contains signal detection circuitry to transmit/ receive the light signals through the endoscope confocal imaging module. The detected signal is sent to the system computer. The System Computer processes the confocal image information for display on the confocal monitor, controls the laser light source, and acts as an image storage device for still frame images. The endoscope is immersable (with the use of supplied cleaning accessories).

Intended Use:
The EC-3870C1LK, Confocal Video Colonoscope, is intended to provide optical visualization (via a video monitor), (confocal) microscopic visualization of (via a video monitor), and therapeutic access to, the Lower Gastrointestinal Tract. The Lower Gastrointestinal Tract includes, but is not restricted to, the organs; tissues; and subsystems: Large Bowel. The instrument is introduced per rectally when indications consistent with the requirement for the procedure are observed in adult and pediatric patient populations.

Comparison To Predicated Device(s):
The submission for substantial equivalence included EC-3870C1LK literature including specifications, the identification of standard set components, and identification of optional accessories, comparison tables were provided to illustrate the comparisons to the predicated devices. The submission for substantial equivalence was not based on an assessment of clinical performance data.

Prepared By:
09-09-2004
Date

Control Number: PS-726.EC-3870C1LK.510KS page 1 of 1

Revision: a