Bronchi and Gastrointestinal Cytology Brush

K171607 · Wilson-Cook Medical Inc./Cook Endoscopy · FDX · Jul 31, 2017 · Gastroenterology, Urology

Device Facts

• Record ID: K171607
• Device Name: Bronchi and Gastrointestinal Cytology Brush
• Applicant: Wilson-Cook Medical Inc./Cook Endoscopy
• Product Code: FDX · Gastroenterology, Urology
• Decision Date: Jul 31, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.1500
• Device Class: Class 2

Intended Use

This device is used to collect cells from the bronchi and/or upper and lower gastrointestinal tracts.

Device Story

Sterile, single-use endoscopic accessory; consists of stainless steel coil spring with distal nylon brush; housed within extruded polytetrafluoroethylene (PTFE) sheath. Operated by advancing/retracting brush from sheath via endoscope accessory channel. Used by clinicians during bronchoscopy or gastrointestinal endoscopy to collect cellular samples for diagnostic evaluation. Benefits patient by enabling minimally invasive tissue sampling for pathology.

Clinical Evidence

Bench testing only. Performance data includes sterilization validation, shelf life testing, biocompatibility, and nonclinical bench testing to confirm device meets performance requirements.

Technological Characteristics

Materials: stainless steel (coil spring), nylon (brush), polytetrafluoroethylene (sheath). Form factor: flexible catheter-style device for endoscope accessory channel. Sterilization: sterile, single-use.

Indications for Use

Indicated for the collection of cells from the bronchi or upper and lower gastrointestinal tracts in patients undergoing endoscopic 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

• Wilson-Cook Cytology Brush (K896318)

Submission Summary (Full Text)

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July 31, 2017

Wilson-Cook Medical, Inc. / Cook Endoscopy Doris A. Hawks Global Regulatory Affairs Specialist 4900 Bethania Station Road Winston-Salem, NC 27105

- Re: K171607
Trade/Device Name: Bronchi and Gastrointestinal Cytology Brush Regulation Number: 21 CFR§ 876.1500 Regulation Name: Endoscope and Accessories Regulatory Class: II Product Code: FDX Dated: May 31, 2017 Received: June 1, 2017

Dear Doris A. Hawks:

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 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.

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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 Industry and Consumer Education 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" (21 CFR 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely.

Joyce M. Whang -S

for

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)

K171607

Device Name

Bronchi and Gastrointestinal Cytology Brush

Indications for Use (Describe)

This device is used to collect cells from the bronchi or upper and lower gastrointestinal tracts.

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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Image /page/3/Picture/1 description: The image shows the logo for Cook Medical. The word "COOK" is in large, white, sans-serif font on a red background. Below the word "COOK" is the word "MEDICAL" in a smaller, white, sans-serif font on a red background. The "R" in "COOK" has a circle around it, indicating that it is a registered trademark.

COOK ENDOSCOPY 4900 BETHANIA STATION ROAD WINSTON-SALEM, NC 27105 U.S.A. NE: 336.744.0157 TOLL FREE: 800.245.4707 WWW.COOKMEDICAL.COM

#### 009. 510(k) Summary

# Bronchi and Gastrointestinal Cytology Brush

Traditional 510(k) Premarket Notification May 31, 2017

## Applicant Information

| Applicant: | Wilson-Cook Medical, Inc. /Cook Endoscopy<br>4900 Bethania Station Road<br>Winston-Salem, North Carolina 27105 |
|------------|----------------------------------------------------------------------------------------------------------------|
| Contact: | Doris A. Hawks, Global Regulatory Affairs Specialist |
| Phone: | [phone] ext. 396293 |
| Fax: | [phone] |

### Device Information

| Trade Name: | Bronchi and Gastrointestinal Cytology Brush |
|----------------------|---------------------------------------------|
| Common Name: | Endoscopic Cytology Brush |
| Classification Name: | Endoscope and Accessories |
| Regulation Number: | 21 CFR 876.1500 |
| Product Code: | FDX |
| Device Class: | Class II |
| Review Panel: | Gastroenterology-Urology |

# Predicate Device

| Name: | Wilson-Cook Cytology Brush |
|----------------|----------------------------|
| 510(k) Number: | K896318 |
| Date: | Cleared April 9, 1990 |

# Device Description

The Bronchi and Gastrointestinal Cytology Brush (subject device) is a sterile, single use device compatible with the accessory channel of endoscopes. The device consists of stainless steel coil spring terminating in a nylon brush at the distal end. The coil spring and brush are secured inside an extruded polytetrafluoroethylene sheath. The brush is advanced from and retracted into the sheath.

### Intended Use

This device is used to collect cells from the bronchi and/or upper and lower gastrointestinal tracts.

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Image /page/4/Picture/0 description: The image shows the Cook Medical logo. The word "COOK" is in large, white, sans-serif font on a red background. Below the word "COOK" is the word "MEDICAL" in a smaller, white, sans-serif font. The "COOK" logo has a registered trademark symbol.

Page 2 of 2 cook endoscopy 4900 BETHANIA STATION ROAD WINSTON-SALEM, NC 27105 U.S.A. ONE: 336.744.0157 TOLL FREE: 800.245.4707 WWW.COOKMEDICAL.COM

K171607

# Comparison to Predicate Device

The Bronchi and Gastrointestinal Cytology Brush has the same intended use, principles of operation, fundamental technologies, and materials of construction as the predicate device. The changes to the subject device involve labeling, incorporating the addition of an Instructions for Use with contraindications, and metric dimensional units. These changes do not raise any new questions of safety or effectiveness.

### Performance Data

Performance testing consisting of sterilization, shelf life, biocompatibility, and nonclinical bench testing demonstrate that the Bronchi and Gastrointestinal Cytology Brush meets the performance requirements to fulfill the intended use of the device.