FUJIFILM Endoscope Model EI-740D/S

K221551 · Fujifilm Corporaton · FDS · Jan 27, 2023 · Gastroenterology, Urology

Device Facts

• Record ID: K221551
• Device Name: FUJIFILM Endoscope Model EI-740D/S
• Applicant: Fujifilm Corporaton
• Product Code: FDS · Gastroenterology, Urology
• Decision Date: Jan 27, 2023
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

FUJIFILM Endoscope Model EI-740D/S is intended for the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenum. This device is also intended for the visualization of the lower digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the rectum and sigmoid colon. Never use this product for any other purposes.

Device Story

Flexible endoscope for visualization and treatment of upper and lower GI tracts. Device comprises control section, insertion tube with glass fiber bundles for illumination, multiple channels for air/suction/accessories, and distal CCD image sensor. Operates by connecting to FUJIFILM video processor and light source; captures and displays images on external monitor. Used by physicians in clinical settings. Supports specialized imaging modes (FICE, BLI, LCI, OXEI). OXEI mode enables oxygen saturation (StO2) measurement when used with EX-0 processor. Provides visual feedback for diagnosis and therapeutic intervention; facilitates minimally invasive procedures.

Clinical Evidence

Bench testing only. Reprocessing validation performed per FDA guidance. StO2 measurement (OXEI mode) testing adopted from Endoscope Model EG-740N (K203717). Electrical safety and EMC evaluated per ANSI/AAMI ES 60601-1, IEC 60601-1-2, and IEC 60601-2-18. Photobiological safety evaluated per IEC 62471.

Technological Characteristics

Flexible endoscope; 12.8mm distal/flexible diameter; 140-degree FOV; 3-100mm observation range. Features dual forceps channels (3.2mm/3.7mm). Connectivity: FUJIFILM video processors (VP-7000, EP-6000) and light sources (BL-7000/X). Imaging modes: FICE, BLI, LCI, OXEI. Standards: ANSI/AAMI ES 60601-1:2012, IEC 60601-1-2:2014, IEC 60601-2-18:2009, IEC 62471:2006.

Indications for Use

Indicated for observation, diagnosis, and endoscopic treatment of the upper digestive tract (esophagus, stomach, duodenum) and lower digestive tract (rectum, sigmoid colon).

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

• Endoscope Model EI-740D/S (K210162)

Reference Devices

• Endoscope Model EG-740N (K203717)

Submission Summary (Full Text)

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January 27, 2023

FUJIFILM Corporation % Kotei Aoki Senior Regulatory Affairs Specialist FUJIFILM Healthcare Americas Corporation 81 Hartwell Avenue, Suite 300 Lexington, MA 02421

Re: K221551

> Trade/Device Name: FUJIFILM Endoscope Model EI-740D/S Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: FDS, FAM Dated: December 22, 2022 Received: December 22, 2022

Dear Kotei Aoki:

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

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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-safetyreporting-combination-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-devices/medical-device-safety/medicaldevice-reporting-mdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medical-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-devices/device-advicecomprehensive-regulatory-assistance/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 -S

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

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# Indications for Use

510(k) Number (if known)

#### K221551

Device Name FUJIFILM Endoscope Model EI-740D/S

#### Indications for Use (Describe)

FUJIFILM Endoscope Model El-740D/S is intended for the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenum.

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

Never use this product for any other purposes.

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

| <span style="font-family: Arial, sans-serif;"> <span style="font-size: 10pt;"> <input checked="true" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D) </span> </span> |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| <span style="font-family: Arial, sans-serif;"> <span style="font-size: 10pt;"> <input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </span> |

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K221551 Page 1 of 3

# 510(k) Summary

# FUJIFILM Corporation

# FUJIFILM Endoscope Model El-740D/S

Date: May 25, 2022

#### Submitter's Information:

FUJIFILM Corporation 798 MIYANODAI KAISEI-MACHI ASHIGARAKAMI-GUN, KANAGAWA 258-8538 JAPAN

# Contact Person:

Kotei Aoki Senior Regulatory Affairs Specialist E-Mail: [e-mail] Telephone: [phone]

# ldentification of the Proposed Device:

| Device Name: | FUJIFILM Endoscope Model EI-740D/S |
|-------------------------|------------------------------------|
| Common Name: | Endoscope |
| Product Code: | FDS, FAM |
| Device Class: | II |
| Regulation Number: | 876.1500 |
| Regulation Description: | Endoscope and accessories |
| Review Panel: | Gastroenterology/Urology |

# Predicate Device(s):

- Endoscope Model El-740D/S (K210162) .
# Intended Use / Indications for Use:

FUJIFILM Endoscope Model EI-740D/S is intended for the upper digestive tract, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenum.

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

Never use this product for any other purposes

# Device Description:

FUJIFILM Endoscope Model EI-740D/S is comprised of three general sections: a control portion, an insertion portion and an umbilicus. The control portion controls the angulation of the endoscope. The insertion portion contains glass fiber bundles, several channels and a charge-coupled device (CCD) image sensor in its distal end. The channels in the insertion portion assist in delivering air/suction as well as endoscope accessories, such as forceps. The glass fiber bundles allow light to travel through the endoscope and emit light from the tip of the insertion portion to illuminate the body cavity. This provides enough light to the CCD image sensor to capture an image and display it on the monitor. The umbilicus

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consists of electronic components needed to operate the endoscope when plugged in to the video processor and the light source. The endoscope is used in combination with FUJIFILM's video processor, FUJIFILM's light sources and peripheral devices such as monitor, printer, foot switch, and cart.

# Comparison of Technological Characteristics:

A comparison of technological characteristics between the proposed device and the predicate device is provided in Table 1:

| | | Proposed Device<br>FUJIFILM Endoscope<br>Model El-740D/S<br>(To be assigned) | Predicate Device<br>FUJIFILM Endoscope<br>Model El-740D/S<br>(K210162) |
|--------------------------------------|-------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------|
| Indications for Use (IFU) | | FUJIFILM Endoscope Model El-740D/S is intended for the visualization<br>of the upper digestive tract, specifically for the observation, diagnosis,<br>and endoscopic treatment of the esophagus, stomach, and duodenum.<br>This device is also intended for the visualization of the lower digestive<br>tract, specifically for the observation, diagnosis, and endoscopic | |
| | | treatment of the rectum and sigmoid colon.<br>Never use this product for any other purposes. | |
| Light Source/Video Processor | | BL-7000/VP-7000<br>BL-7000X/VP-7000<br>EP-6000 | BL-7000/VP-7000<br>EP-6000 |
| Oxygen Saturation Image<br>Processor | | EX-0 | Not Available |
| Delayed Reprocessing | | Yes | No |
| Viewing direction | | Forward/ 0 degree | |
| Observation range | | 3mm-100mm | |
| Field of View | | 140 degrees | |
| Distal end diameter | | 12.8mm | |
| Flexible portion diameter | | 12.8mm | |
| Maximum insertion diameter | | 14.3mm | |
| Bending<br>capability | Up | 210 degrees | |
| | Down | 90 degrees | |
| | Right | 100 degrees | |
| | Left | 100 degrees | |
| Forceps channel diameter | | (1st Channel) 3.2mm<br>(2nd Channel) 3.7mm | |
| Working length | | 1030mm | |
| Total length | | 1330mm | |
| FICE | | Available | |
| BLI | | Available | |
| BLI-bright | | Available | |
| LCI | | Available | |
| OXEI mode | | Available | Not Available |

# Table 1 Comparison of the features

# Performance Data:

The proposed device was adopted into the cleaning, disinfection, and sterilization of the predicate device. Validation of the delayed reprocessing instructions was performed in accordance with

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the FDA's guidance, Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling, issued March 17, 2015.

The proposed device was adopted into the StO2 measurement (in OXEI mode) testing performed on the EX-0 Oxygen Saturation Image Processor paired with the Endoscope Model EG-740N (K203717).

EMC and Electrical safety of the proposed device was evaluated using following standards: ANSI/AAMI ES 60601-1:2012, IEC 60601-1-2:2014, and IEC 60601-2-18:2009.

Photobiological safety of the proposed device were evaluated using the following standard: IEC 62471:2006.

No modification has been proposed in the material construction, patient contact type/duration, or other technological characteristics. The proposed device FUJIFILM Endoscope Model El-740D/S can be adopted into the biocompatibility and the performance testing of the Endoscope Model El-740D/S (K210162).

# Conclusions:

The proposed device FUJIFILM Endoscope Model EI-740D/S shares the same intended use and indications, materials of construction, and electrical components as the predicate device. The reprocessing validation demonstrates that the proposed device can be cleaned as effective as the predicate device. Thus, FUJIFILM Endoscope Model El-740D/S is substantially equivalent to the predicate device, Endoscope Model EI-740D/S (K210162).