FUJINON COLONOSCOPES

K112391 · Fujinon, Inc. · FDF · Jul 26, 2012 · Gastroenterology, Urology

Device Facts

• Record ID: K112391
• Device Name: FUJINON COLONOSCOPES
• Applicant: Fujinon, Inc.
• Product Code: FDF · Gastroenterology, Urology
• Decision Date: Jul 26, 2012
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

This device is intended for the visualization of the lower digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the rectum and large intestine.

Device Story

Flexible colonoscope (models EC-530HL2, EC-530LS2) used for lower digestive tract visualization, diagnosis, and treatment. Device features operation section for angulation control; flexible insertion portion containing glass fiber bundles for illumination, CCD for image capture, and multiple channels for air/water, suction, and instrument passage (e.g., biopsy forceps). Umbilicus connects to external video processor, light source, and monitor. Operated by physicians in clinical settings. Provides real-time visual feedback to clinicians to facilitate diagnostic and therapeutic procedures. Benefits include direct visualization of lower GI tract for improved diagnostic accuracy and minimally invasive treatment capabilities.

Clinical Evidence

No clinical data. Bench testing only, including compliance with IEC 60601-1, IEC 60601-1-1, IEC 60601-1-2, IEC 60601-2-18, and ISO 10993. Reprocessing instructions were validated by a third-party lab.

Technological Characteristics

Flexible endoscope with CCD imaging sensor, fiber optic illumination, and working channels. Materials evaluated per ISO 10993. Connectivity via umbilicus to external video processor/light source. Standards: IEC 60601-1, IEC 60601-1-1, IEC 60601-1-2, IEC 60601-2-18.

Indications for Use

Indicated for visualization, diagnosis, and endoscopic treatment of the rectum and large intestine in patients requiring lower gastrointestinal endoscopy.

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

• Fujinon G5 Colonoscopes, Model EC-450HL5 and EC-250HL5 (K041903)

Submission Summary (Full Text)

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K-112391

JUL 2 6 2012

# 510(k) Summary

## Date: February 27, 2012

## Submitter's Information:

Fujifilm Medical Systems U.S.A., Inc. 10 High Point Drive Wayne, NJ 07470 USA

### Contact Person:

| Name: | Gina Walljasper |
|------------|---------------------------------------------|
| Title: | Director, Quality and Regulatory Compliance |
| Telephone: | [phone] |
| Facsimile: | [phone] |
| E-Mail: | [e-mail] |

## Identification of the Proposed Device:

Proprietary/Trade Name: Common Name: Device Class: Review Panel: Classification Information: Fujinon Colonoscopes, EC-530HL2 and EC-530LS2 Colonoscope Class 2 Gastroenterology/Urology

Classification Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Colonoscope and accessories, Flexible/Rigid | 21 CFR 876.1500 FDF

#### l. INDICATIONS FOR USE

This device is intended for the visualization of the lower digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the rectum and large intestine.

#### II. DEVICE DESCRIPTION

Fujinon Colonoscope EC-530HL2 and EC-530LS2 are modified versions of our previouslycleared Fujinon G5 Colonoscopes, Model EC-450HL5 and EC-250HL5 as described in K041903. The modified models are intended for observation, diagnosis, and endoscopic treatment of the lower digestive tract, which includes rectum, sigmoid colon, and large intestine, which remains the same as K041903.

The endoscopes are comprised of three general sections: an operation section, a flexible The operation section controls the angulation and an umbilicus. portion (up/down/left/right) of the distal end of the endoscope. The flexible insertion portion contains glass fiber bundles, several channels and a charged couple device (CCD). The

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# FUJKFILN

glass fiber bundles allow light to travel through the endoscope to illuminate the body cavity thereby providing enough light to the CCD to capture an image and display the image on the monitor. The endoscope also contains several channels to deliver air/water, provide suction and a working channel. The forceps channel or working channel is used to introduce endoscope accessories such as biopsy forceps. The umbilicus contains electronic components needed to operate the endoscope when plugged to the video processor and the light source.

The modified models are used in combination with Fujinon's video processor, light source, monitor, cart, foot switch, endoscope accessories and other peripheral devices.

#### ���. SUMMARY OF STUDIES

Fujinon Colonoscope EC-530HL2 and EC-530LS2 were evaluated in accordance with following safety and performance requirements in addition to the applicable quality system regulations:

| IEC 60601-1 | Medical electrical equipment - Part 1: General requirements for<br>safety |
|---------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| IEC60601-1-1 | Medical electrical equipment - Part 1-1: General requirements for<br>safety - Collateral standard: Safety requirements for medical<br>electrical systems |
| IEC60601-1-2 | Medical electrical equipment - Part 1-2: General requirements for the<br>basic safety and essential performance - Collateral standard:<br>Electromagnetic compatibility - Requirements and tests |
| IEC60601-2-18 | Medical electrical equipment - Part 2-18: Particular requirements for<br>the safety of endoscopic equipment |
| ISO10993 | Biological evaluation of medical devices |

The reprocessing instructions were updated and validated using a third party lab. No clinical test was conducted.

#### SUBSTANTIAL EQUIVALENCE IV.

Fujinon Colonoscopes EC-530HL2 and EC-530LS2 are substantially equivalent to the following device:

| Legally Marketed Device College Comment Comment (1) = (510(k) # = ============================================================================================================ | |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------|
| ' Fujinon G5 Colonoscopes, Model EC-450HL5 and EC-250HL5 | K041903 |

EC-530HL2 and EC-530LS2 colonoscopes have the same indications for use as the legally marketed device. The minor dimensional changes, material changes and relocation of the water jet inlet do not adversely affect the safety and effectiveness of the subject colonoscopes.

#### V. CONCLUSION

Fujinon Colonoscopes EC-530HL2 and EC-530LS2 are substantially equivalent to the legally marketed device and conforms to applicable medical device safety and performance standards.

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Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized eagle with three stripes forming its wing and tail. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle.

# DEPARTMENT OF HEALTH & HUMAN SERVICES

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

Ms. Gina Walljasper Director Quality and Regulatory Compliance Fujifilm Medical Systems U.S.A., Inc. 10 High Point Drive WAYNE NJ 07470

JUL 26 2012

Re: K112391

Trade/Device Name: Fujinon Colonoscopes EC-530HL2 and EC-530LS2 Regulation Number: 21 CFR§ 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: FDF Dated: July 25, 2012 Received: July 25, 2012

Dear Ms. Walljasper:

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 for are barrant 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). and Cosmeter For (. 10) in the device, subject to the general controls provisions of the Act. The r ou may, attrefery, interes of the Act include requirements for annual registration, listing of genoral controls provisioning 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 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 or any I vath all the Act's requirements, including, but not limited to: registration and listing లంగippy "Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical

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device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set de vice-related adverse overse) (21 CFR Part 820); and if applicable, the electronic forth in the quality by bellions (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 11 70d don't specific an 14boutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please the conter tol Do 1000 and ing by reference to premarket notification" (21CFR Part nove the regulations 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 I va may other buttor ground and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Dayana K-Euker
Benjamin C. Fisher, Ph.D.

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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# Indications for Use

510(k) Number (if known): ___K112391___

Device Name: Fujinon Colonoscopes EC-530HL2 and EC-530LS2

Indications for Use:

This device is intended for the visualization of the lower digestive tract, specifically. for the observation, diagnosis, and endoscopic treatment of the rectum and large intestine.

Prescription Use X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Reproductive, Gastro-Renal, and
Urological Devices