Diathermic Slitter (FlushKnife) DK2620JI and DK2623JI

K220053 · Fujifilm Corporation · KGE · Feb 4, 2022 · Gastroenterology, Urology

Device Facts

• Record ID: K220053
• Device Name: Diathermic Slitter (FlushKnife) DK2620JI and DK2623JI
• Applicant: Fujifilm Corporation
• Product Code: KGE · Gastroenterology, Urology
• Decision Date: Feb 4, 2022
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.4300
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

These products are used in combination with an applicable endoscope to perform the endoscopic treatments for the target site in the gastrointestinal tract, such as ablation, incision, cauterization, coagulation and avulsion of tissue and arrest of bleeding, and to inject saline or submucosal injection agent for endoscopic surgery into the submucosal layer in the gastrointestinal tract, which is exposed after dissection, under the management of physicians in medical facilities. Never use this product for any other purpose.

Device Story

FlushKnife DK2620JI/DK2623JI is a monopolar electrosurgical instrument used with an endoscope for gastrointestinal procedures. Device features needle or ball tip slitter to deliver high-frequency electrical current for tissue cutting, coagulation, and hemostasis. Integrated water feed function allows injection of saline or submucosal agents. Operated manually via handle slider by physicians in medical facilities. Rotatable water supply connector improves usability compared to predicate. Device is single-use and sterile. Output is thermal energy for tissue modification; clinical benefit includes precise tissue dissection and bleeding control during endoscopic surgery.

Clinical Evidence

Bench testing only. Evaluated electrical safety (ANSI/AAMI ES60601-1, IEC 60601-2-2/18), electromagnetic compatibility (IEC 60601-1-2), biocompatibility (ISO 10993 series), and sterility (ISO 11135). Device-specific bench testing validated compatibility with submucosal injection agents and confirmed performance specifications for insertion diameter, working length, slitter length, conductivity, and liquid delivery. No clinical data provided.

Technological Characteristics

Monopolar electrosurgical instrument; needle or ball tip; manual operation via handle slider. Features rotatable water supply connector. Single-use; sterile. Complies with ISO 10993 (biocompatibility), ISO 11135 (sterility), and IEC 60601 series (electrical/EMC).

Indications for Use

Indicated for patients requiring endoscopic gastrointestinal surgery for tissue ablation, incision, dissection, cauterization, coagulation, avulsion, hemostasis, and submucosal injection of saline or agents.

Regulatory Classification

Identification

An endoscopic electrosurgical unit and accessories is a device used to perform electrosurgical procedures through an endoscope. This generic type of device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self-opening rigid snare, flexible suction coagulator electrode, patient return wristlet, contact jelly, adaptor to the cord for transurethral surgical instruments, the electric cord for transurethral surgical instruments, and the transurethral desiccator.

Predicate Devices

• FUJIFILM Diathermic Slitter FlushKnife (K171096)

Reference Devices

• Eleview (K150852)
• ORISE Gel (K180068)

Submission Summary (Full Text)

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February 4, 2022

FUJIFILM Corporation % Dhara Buch Regulatory Affairs Specialist FUJIFILM Healthcare Americas Corporation 81 Hartwell Avenue, Suite 300 Lexington, MA 02421

Re: K220053

> Trade/Device Name: Diathermic Slitter (FlushKnife) DK2620JI and DK2623JI Regulation Number: 21 CFR 876.4300 Regulation Name: Endoscopic electrosurgical unit and accessories Regulatory Class: Class II Product Code: KGE Dated: January 5, 2022 Received: January 6, 2022

Dear Dhara Buch:

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.

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

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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 (OS) 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 ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Shanil P. Haugen, Ph.D. 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

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# Indications for Use

510(k) Number (if known) K220053

Device Name

FUJIFILM Diathermic Slitter (FlushKnife) DK2620JI and DK2623JI

Indications for Use (Describe)

These products are used in combination with an applicable endoscope to perform the endoscopic treatments for the target site in the gastrointestinal tract, such as ablation, incision, cauterization, coagulation and avulsion of tissue and arrest of bleeding, and to inject saline or submucosal injection agent for endoscopic surgery into the submucosal layer in the gastrointestinal tract, which is exposed after dissection, under the management of physicians in medical facilities. Never use this product for any other purpose.

| Type of Use (Select one or both, as applicable) |
|-------------------------------------------------------------------------------------------------|
| <label><input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D)</label> |
| <label><input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C)</label> |

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#### 510(k) Summary

### FUJIFILM Corporation

### FUJIFILM Diathermic Slitter (FlushKnife) DK2620JI and DK2623JI

Date: January 05, 2021

# Submitter's Information:

FUJIFILM Corporation 798 Miyanodai Kaisei-Machi Ashigarakami-Gun, Kanagawa, 258-8538, Japan

# Contact Person:

Dhara Buch Requlatory Affairs Specialist Phone: [phone] E-Mail: dhara.buch(@fujifilm.com

# Identification of the Proposed Device:

| Device Name: | FUJIFILM Diathermic Slitter (FlushKnife) DK2620J<br>and DK2623JI |
|-----------------|------------------------------------------------------------------|
| Common Name: | Electrosurgical Instruments |
| Product Code: | KGE |
| Device Class: | Class II |
| Classification: | Endoscopic electrosurgical unit and accessories |
| | 21 C.F.R. § 876.4300 |
| Review Panel: | Gastroenterology/Urology |

#### Predicate Device:

- FUJIFILM Diathermic Slitter FlushKnife (K171096)
#### Intended Use / Indications for Use:

These products are used in combination with an applicable endoscope to perform the endoscopic treatments for the target site in the gastrointestinal tract, such as ablation, incision, dissection, cauterization, coagulation and avulsion of tissue and arrest of bleeding, and to inject saline or submucosal injection agent for endoscopic surgery into the submucosal layer in the gastrointestinal tract, which is exposed after dissection, under the management of physicians in medical facilities. Never use this product for any other purpose.

# Device Description:

FUJIFILM Diathermic Slitter (FlushKnife) is an electrosurgical instrument that removes tissue and controls bleeding by use of high-frequency ("HF") electrical current. The device is available with either a needle or ball tip slitter and comes in a variety of sizes.

# Comparison of Technological Characteristics:

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A comparison of technological characteristics between subject device and the predicate device is provided table below:

| Device Details | Predicate Device | Subject Device |
|------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Device Name | FUJIFILM Diathermic Slitter Knife | FUJIFILM Diathermic Slitter<br>(FlushKnife) DK2620JI and<br>DK2623JI |
| Model | MODEL DK2618J -N10-, DK2618J -<br>N15-, DK2618J -N20-, DK2618J -N25-,<br>DK2618J -N30-, DK2618J -B15-,<br>DK2618J -B20-, DK2618J -B25-,<br>DK2618J -B30-, DK2623J -N15-,<br>DK2623J -N20-, DK2623J -B15-,<br>DK2623J -B20- | MODEL DK2620JI N10-,<br>DK2620JI -N15, DK2620JI -N20-<br>, DK2620JI -N25-, DK2620JI -<br>N30-, DK2620JI -B15-,<br>DK2620JI -B20-, DK2620JI -<br>B25-, DK2620JI -B30-,<br>DK2623JI -N15-, DK2623JI -<br>N20-, DK2623JI -B15-,<br>DK2623JI -B20- |
| 510(k) number | K171096 | To be assigned |
| Product code | KGE | KGE |
| Manufacturer | FUJIFILM Corporation | FUJIFILM Corporation |
| Intended Use | This instrument is designed to be used<br>with specified endoscopes to cut tissue<br>within the digestive tract and using high-<br>frequency current. Both of the ball tip<br>type and the needle type instruments<br>are indicated for ablation, incision,<br>dissection, avulsion, cauterization,<br>coagulation and hemostasis of tissue<br>within the digestive tract. | These products are used in<br>combination with an applicable<br>endoscope to perform the<br>endoscopic treatments for the<br>target site in the gastrointestinal<br>tract, such as ablation, incision,<br>dissection, cauterization,<br>coagulation and avulsion of<br>tissue and arrest of bleeding,<br>and to inject saline or<br>submucosal injection agent for<br>endoscopic surgery into the<br>submucosal layer in the<br>gastrointestinal tract, which is<br>exposed after dissection, under<br>the management of physicians in<br>medical facilities. |
| Slitter Length | 1.0/1.5/2.0/2.5/3.0mm (for DK2618J<br>series)<br>1.5/2.0mm (for DK2623J series) | Same as K171096 |
| Slitter Diameter | 0.5mm | Same as K171096 |
| Slitter Shape | Needle Type<br>(With Ball Tip:-BXX-)<br>(Without Ball Tip:-NXX-) | Same as K171096 |
| Maximum Diameter<br>of Insertion Portion | 2.7mm | Same as K171096 |
| Water Feed Function | Yes | Same as K171096 |
| Method of Operation | Manually (handle slider) | Same as K171096 |
| Water supply<br>connector | Yes, fixed | Yes, rotatable |
| Energy | Energy delivered from an<br>electrosurgical generator | Same as K171096 |
| Monopolar /<br>Bipolar | Monopolar | Same as K171096 |
| Sterilization | Yes (Single Use Device) | Same as K171096 |
| Combination<br>Tools | Endoscope, Electrosurgical generator,<br>A Cord, Water supply unit | Endoscope, Electrosurgical<br>generator, A Cord |
| Injection agent | Saline and other sterile liquids | Saline, Eleview (K150852),<br>ORISE Gel(K180068) |

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#### Performance Data:

Electrical safety and electromagnetic compatibility of the proposed device was evaluated using the following standards: ANSI/AAMI ES60601-1:2005/(R)2012, IEC 60601-1-2:2014, IEC 60601-1-6:2013, IEC 60601-2-2:2017, and IEC 60601-2-18:2009.

Biocompatibility of the proposed device was evaluated using the following consensus standards: ISO 10993-1:2018, ISO 10993-5:2009, ISO 10993-7:2008, ISO 10993-10:2010, and ISO 10993-11:2017. Biocompatibility testing was performed in accordance with FDA's guidance, "Use of International Standard ISO 10993-1, 'Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process,"" published September 4, 2020.

Sterility of the proposed device was evaluated according to ISO 11135:2014 and the FDA guidance "Submission and Review of Sterility Information in Premarket Notification (510(k)) Submissions for Devices Labeled as Sterile".

Device specific testing was conducted using the following consensus standard: ISO 8600-1:2015. Bench testing was conducted to validate the compatibility of subject device with submucosal injection agent.

The proposed device met performance specifications in the following additional testing:

- Maximum diameter of insertion portion
- . Working length
- Slitter length
- Conductivity
- Liquid delivery amount ●

In all cases, the device met the pre-defined acceptance criteria for the test.

#### Conclusions:

The subject device shares the same intended use and similar indications as the predicate device (K171096).

Bench testing demonstrates that the subject device is as safe and effective as the predicate device. Thus, subject device is substantially equivalent to the predicate device.