EndoClot

K191254 · Endoclot Plus Co., Ltd. · PLL · Jan 30, 2020 · Gastroenterology, Urology

Device Facts

Record IDK191254
Device NameEndoClot
ApplicantEndoclot Plus Co., Ltd.
Product CodePLL · Gastroenterology, Urology
Decision DateJan 30, 2020
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2
AttributesTherapeutic

Indications for Use

EndoClot® Submucosal Injection Agent is intended for use in gastrointestinal endoscopic procedures for submucosal lift of polyps, adenomas, early stage cancers or other gastrointestinal mucosal lesions, prior to excision with a snare or endoscopic device.

Device Story

EndoClot Submucosal Injection Agent consists of Absorbable Modified Polymer (AMP) particles and a spiral plunger syringe. Clinician dissolves AMP particles in sterile 0.9% saline; injects resulting agent into submucosal layer via standard endoscopic injection needle attached to spiral plunger syringe. Device used in GI endoscopic procedures; operated by endoscopist. Agent creates submucosal lift; facilitates excision of polyps, adenomas, or early-stage cancers by snare or other endoscopic devices. Benefits include improved cushion-forming duration compared to predicate.

Clinical Evidence

Bench testing, biocompatibility, and animal studies conducted. Bench tests compared pH, density, viscosity, and osmolality; showed improved cushion-forming duration vs predicate. Biocompatibility testing followed ISO 10993 series, OECD guidelines, ASTM F756-13, and USP40 NF35<85>. Sterility testing per ISO 11737-2. Porcine model animal study validated efficacy and safety for submucosal lift during EMR/ESD procedures compared to SIC 8000 predicate.

Technological Characteristics

Composed of Absorbable Modified Polymer (AMP) particles and spiral plunger syringe. Materials tested per ISO 10993 (biocompatibility) and ASTM F756-13. Sterilization per ISO 11737-2. Manual injection mechanism via Luer lock syringe. No electronic components or software.

Indications for Use

Indicated for patients undergoing gastrointestinal endoscopic procedures requiring submucosal lift of polyps, adenomas, early stage cancers, or other mucosal lesions prior to excision.

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.

In combination with the general controls of the FD&C Act, the integrated operating table-electromechanical surgical system is subject to the following special controls: 1. (1) Premarket clinical performance testing, or a combination of premarket clinical performance testing and postmarket surveillance (in accordance with special control (2)), must include the following: 1. (i) Objective performance measures (e.g., rate and number of conversions to other surgical modalities, rate of device related adverse events (including tissue injury, hematoma, and increased blood loss), and their severity, cause, and outcomes) must be reported with relevant descriptive comparator performance measures. 2. (ii) The data must demonstrate the performance of the device for providing accurate and precise control of attached surgical instruments in range of clinical conditions relevant to the device's intended use. 3. (iii) The test dataset must include data collected from a patient population representative of the intended patient population under anticipated conditions of use. 2. (2) Data obtained from postmarket surveillance must demonstrate, in consideration of the premarket data obtained in accordance with special control (1), that the device performs in accordance with special control (1), unless FDA determines, based on the totality of the premarket data, that data from postmarket surveillance is not required to demonstrate that the device performs as intended. Such postmarket surveillance must be conducted per a protocol determined appropriate by FDA to demonstrate that the device performs as intended (in consideration of the premarket data obtained in accordance with special control (1)), and must include initiation, enrollment, and reporting requirements to ensure timely periodic updates to FDA on post-market surveillance progress and outcomes. 3. (3) Animal performance testing must evaluate the extent of port site trauma due to repositioning of table during surgical procedures when utilizing robotic minimally invasive and laparoscopic approaches 4. (4) The device manufacturer must develop, and update as necessary, a device-specific use training program that ensures proper device setup/use/shutdown, accurate control of instruments to perform the intended surgical procedures, troubleshooting and handling during unexpected events or emergencies, and safe practices to mitigate use error. 5. (5) The device manufacturer may only distribute the device to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program. (6) Human factors assessment must demonstrate that the user can correctly use the device system across all intended use environments with the provided instructions and training materials, including patient access during normal operating conditions and emergency situations, and effects arising from the integrated nature of the operating table and robotic surgical arms. (7) Labeling must include: (i) A detailed summary of clinical performance testing conducted with the device, including study population, results, adverse events, and comparisons to any comparator groups identified; (ii) A statement in the labeling that the safety and effectiveness for the representative specific procedures was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of the patient's underlying disease or condition, unless FDA determines that it can be removed or modified based on clinical performance data submitted to FDA; (iii) Identification of compatible devices; (iv) The list of surgical procedures for which the device has been determined to be safe with clinical justification; (v) Reprocessing instructions for reusable components; (vi) A shelf life for any sterile components; (vii) A description of the device-specific use training program; (viii) A statement that the device is only for distribution to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program; and (ix) A summary of any completed postmarket surveillance data collected as required by special control (2), including updated labeling to accurately reflect outcomes observed in postmarket surveillance. (8) Non-clinical performance testing must demonstrate that the device performs as intended under anticipated conditions of use and must include: (i) Device motion accuracy and repeatability; (ii) System testing; (iii) Instrument reliability; (iv) Crosstalk; (v) Table motion control; (vi) Thermal effects on tissue; (vii) User-device interface performance; (viii) Workspace access testing; and (ix) Performance testing with compatible devices. (9) Software verification, validation, and hazard analysis must be performed. (10) Electromagnetic compatibility and electrical, thermal, and mechanical safety testing must be performed. (11) Performance data must demonstrate the sterility of all patient-contacting device components. (12) Performance data must support the shelf life of the device components provided sterile by demonstrating continued sterility and package integrity over the labeled shelf life. (13) Performance data must validate the reprocessing instructions for the reusable components of the device. (14) Performance data must demonstrate that all patient-contacting components of the device are biocompatible. (15) Performance data must demonstrate that all patient-contacting components of the device are non-pyrogenic. (16) The device manufacturer must submit a report to the FDA annually on the anniversary of initial marketing authorization for the device, until such time as FDA may terminate such reporting, which comprises the following information: (i) Cumulative summary, by year, of complaints and adverse events since date of initial marketing authorization; and (ii) Identification and rationale for changes made to the device, labeling, or device specific use training program, which did not require submission of a premarket notification during the reporting period.

Predicate Devices

Submission Summary (Full Text)

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the FDA logo is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue. January 30, 2020 EndoClot Plus Co., Ltd. % Jonathan Hu Technical Manager Medwheat (Shanghai) Medical Technology Co., Ltd. Yangpu District Liaoyuan East Road Shuangyang First Suite No. 33 Room 303 Shanghai 200093 CHINA Re: K191254 > Trade/Device Name: EndoClot Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: PLL Dated: December 18, 2019 Received: December 26, 2019 Dear Jonathan Hu: 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. {1}------------------------------------------------ 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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems. For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely. Shanil P. Haugen, Ph.D. Acting Assistant Director DHT3A: Division of Renal, Gastrointestinal, Obesity and Transplant Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ ## Indications for Use 510(k) Number (if known) K191254 Device Name EndoClot Indications for Use (Describe) EndoClot® Submucosal Injection Agent is intended for use in gastrointestinal endoscopic procedures for submucosal lift of polyps, adenomas, early stage cancers or other gastrointestinal mucosal lesions, prior to excision with a snare or endoscopic device. | 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) #### CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. #### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: > Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov "An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number." {3}------------------------------------------------ Image /page/3/Picture/2 description: The image shows the logo for EndoClot. The logo is in blue and black, with a red plus sign to the right of the word. The word "EndoClot" is written in a stylized font. Date Prepared: Jan 30th, 2020 # 510(k) Summary [As required by 21 CFR 807.92] # 1. Submitter's Information | Name of Sponsor: | EndoClot Plus Co., Ltd. | |---------------------------------------|------------------------------------------------------------------| | Address: | 101 Room, B8 Building, 218 Xinghu Street, Suzhou Industrial Park | | Contact Name: | Hendry Zhang | | Telephone No.: | 086-512-62605550 | | Fax No.: | 086-512-62605551 | | Email Address: | Hendry@endoclot.com | | <b>2. Correspondent's Information</b> | | | Company Name: | Med-wheat Shanghai | | Correspondent Name: | Jonathan Hu | | Telephone No.: | 86-021-65181421 | |----------------|--------------------------| | Email Address: | Jonathan.hu@medwheat.com | # 3. Trade Name, Common Name, Classification | Trade Name: | EndoClot® | |---------------------------|------------------------------| | Common Name: | Submucosal Injection Agent | | Model Name: | SIA-30 (Former Name: SIS-30) | | Regulation Classification | Endoscope Accessories | | Regulation Number | 21 CFR 876.1500 | | Product Code: | PLL | | Classification Panel: | Gastroenterology/Urology | | Device Class: | II | # 4. Identification of Predicate Device(s) The identified predicates are as follow: The SIC 8000 Submucosal Injection Composition has been cleared by FDA through 510(k) No. K150852 (Decision Date - September 3, 2015). The Merit Syringe has been cleared by FDA through 510(k) No. K173601 (Decision Date -October 3, 2017). {4}------------------------------------------------ #### 510(k) Submission Image /page/4/Picture/2 description: The image shows the word "EndoClot" in a stylized font. The "E" is in a blue, italicized font, and the rest of the word is in a black, sans-serif font. There is a red plus sign to the right of the word. The plus sign is slightly larger than the letters in the word. ## 5. Description of the Device EndoClot® Submucosal Injection Agent is a sterilized single use medical device that is composed of Absorbable Modified Polymer (AMP®) particles in a plastic bottle and a spiral plunger syringe. AMP® particles are dissolved with sterile 0.9% saline to make the agent prior to use. The syringe has a Luer lock fitting to ensure a secure connection to a standard, commercially available endoscopic injection needle. The agent can be injected by rotating the plunger. ## 6. Intended Use/Indication for Use EndoClot® Submucosal Injection Agent is intended for use in gastrointestinal endoscopic procedures for submucosal lift of polyps, adenomas, early stage cancers or other gastrointestinal mucosal lesions, prior to excision with a snare or endoscopic device. ## 7. Technological Characteristics Endoclot® Submucosal Injection Agent is composed of Absorbable Modified Polymer (AMP®) particles in a plastic bottle and a spiral plunger syringe. Prior to use, the AMP® particles are dissolved with sterile 0.9% saline to make the agent. Then the agent is injected into the submucosal layer using our accompanied spiral plunger syringe and a standard, commercially available, endoscopic injection needle. When comparing with the SIC8000 (K150852), the Endoclot® Submucosal Injection Agent has the same intended use, same classification, and same principle of operation which is operated by advancing the plunger within the barrel to inject fluids. Yet, there are also differences, such as product composition, sterilization method, packaging and shelf life. However, substantial equivalence has been demonstrated through verification. When comparing with the Merit Syringe (K173601), the syringe of Endoclot® Submucosal Injection Agent has a smaller scope of intended use and most of the device material is same as that of the predicate device. The differences are the plunger material, piston material, the syringe's structure and shelf life. However, substantial equivalence has been demonstrated through verification. {5}------------------------------------------------ #### 510(k) Submission Image /page/5/Picture/2 description: The image shows the logo for EndoClot. The logo is in blue and black, with a red plus sign to the right of the word "EndoClot". The "E", "N", "D", and "O" are in blue, while the "Clot" is in black. The plus sign is red. ## 8. Performance Data Performance tests, biocompatibility tests, sterility test and animal studies were conducted to demonstrate that the Endoclot® Submucosal Injection Agent and the predicate device are substantially equivalent. According to the performance tests, the properties (pH, density, viscosity and osmolality) of the agent are close to the predicate device, and the Endoclot® Submucosal Injection Agent has better cushion-forming duration. The results demonstrated that the proposed device is substantially equivalent to the predicate device for these performance measures. The biocompatibility tests (ISO10993-5:2009, ISO10993-6:2016, ISO10993-10:2010, ISO 10993-11:2006, OECD 471:1997, OECD 473:2014, OECD 474:2014, ASTM F756-13, USP40 NF35<85>) and sterility test (ISO 11737-2: 2009/(R)2014) in accordance to Food and Drug Administration related guidance and recognized international standards, indicated that the Endoclot® Submucosal Injection Agent is biocompatible and safe for its intended use. Animal studies have also been conducted to support substantial equivalence claims of our product as compared to the predicate device SIC 8000 Submucosal Injection. The objective of this study was to validate the efficacy and safety of EndoClot® Submucosal Injection Agent (compared to the predicate device) for submucosal lift during EMR/ESD procedures in GI tract of a porcine model. The results demonstrated that the proposed device is safe and effective. # 9. Conclusion [21 CFR 807.92(b) (3)] The Endoclot® Submucosal Injection Agent has the same intended use, same classification, and the same principle of operation comparing with the SIC 8000 Submucosal Injection. The syringe of Endoclot® Submucosal Injection Agent has a smaller scope of intended use and almost the same material comparing with the Merit Syringe. A series of tests have been conducted to verify the safety and effectiveness of the Endoclot® Submucosal Injection Agent. - 1) The performance tests demonstrated that the device meets the design specifications and is suitable for the intended use. - 2) The biocompatibility tests and sterility test indicated that the Endoclot® Submucosal Injection Agent is biocompatible and safe for its intended use. - 3) The animal studies demonstrated that the EndoClot® Submucosal Injection Agent is safe and effective. In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807 and based on the information provided in this premarket notification. EndoClot Plus Co., Ltd. concludes that Endoclot® Submucosal Injection Agent is substantially equivalent to the predicate devices with regard to safety and effectiveness.
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