DEFENDO Single Use Valve Kit AW/S Valves - 2pc for OLYMPUS EUS (00711900)

K242742 · STERIS Corporation · ODC · Oct 11, 2024 · Gastroenterology, Urology

Device Facts

• Record ID: K242742
• Device Name: DEFENDO Single Use Valve Kit AW/S Valves - 2pc for OLYMPUS EUS (00711900)
• Applicant: STERIS Corporation
• Product Code: ODC · Gastroenterology, Urology
• Decision Date: Oct 11, 2024
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.1500
• Device Class: Class 2

Intended Use

The DEFENDO EUS Air/Water Valve is intended to be used to control the air/water function of an endoscope during a GI endoscopic procedure. The DEFENDO EUS Suction Valve is intended to be used to control the suction function of an endoscope during a GI endoscopic procedure.

Device Story

Single-use accessory kit for Olympus echoendoscopes; comprises Air/Water valve and Suction valve. Air/Water valve controls air/CO2 insufflation, lens washing, and distal balloon inflation. Suction valve controls suction through accessory channel and distal balloon. Used in clinical GI endoscopic procedures; operated by endoscopist/technician. Mechanical operation via manual valve actuation; no energy delivery. Benefits include maintaining sterile field and proper endoscope function during EUS procedures.

Clinical Evidence

Bench testing only. Testing included leakage, insertion, stationary performance, flow rates, tensile strength, cap torque, and packaging seal integrity. Accelerated aging testing validated the 3-year shelf life.

Technological Characteristics

Materials: PC-ABS, Stainless-Steel, TPE, Ultem, Brass. Dimensions: Air/Water valve (46mm length, 11.25mm diameter); Suction valve (33mm length, 3.8mm stem diameter). Mechanical operation; no energy source. Sterile, single-use. Sterilization: EtO (10^-6 SAL).

Indications for Use

Indicated for patients undergoing GI endoscopic procedures using an Olympus echoendoscope with a balloon channel.

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

• DEFENDO Single Use Valve Kit AW/S Valves – 2pc OLYMPUS EUS (K240098)

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 blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

October 11, 2024

STERIS Corporation Jackie Oliver Sr. Regulatory Affairs Specialist 5960 Heisley Road Mentor, Ohio 44060

Re: K242742

Trade/Device Name: DEFENDO Single Use Valve Kit AW/S Valves - 2pc for OLYMPUS EUS (00711900) Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope And Accessories Regulatory Class: Class II Product Code: ODC, FDF Dated: September 10, 2024 Received: September 11, 2024

Dear Jackie Oliver:

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 (the 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 available 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}------------------------------------------------

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device"

(https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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-regulatory

{2}------------------------------------------------

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

Enclosure

{3}------------------------------------------------

## Indications for Use

Submission Number (if known)

K242742

Device Name

DEFENDO Single Use Valve Kit AW/S Valves - 2pc for OLYMPUS EUS (00711900)

Indications for Use (Describe)

The DEFENDO EUS Air/Water Valve is intended to be used to control the air/water function of an endoscope during an GI Endoscopic procedure.

The DEFENDO EUS Suction Valve is intended to be used to control the suction function of an endoscope during a GI Endoscopic procedure.

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

> 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."

{4}------------------------------------------------

# Special 510(K) Summary For the

## DEFENDO Single Use Valve Kit AW/S Valves -2pc for OLYMPUS EUS

#### 1. Company Name and Address

## 1.1 Sponsor

STERIS Corporation 5960 Heisley Rd. Mentor, Ohio 44060

Jackie Oliver Contact: Senior Regulatory Affairs Specialist Telephone: [phone] Email: Jackie [e-mail]

## 1.2 Manufacturing Facility

US Endoscopy 5976 Heisley Road Mentor, Ohio 44060

#### 2. Device Name

| Proprietary Name: | DEFENDO Single Use Valve Kit AW/S Valves - 2pc for<br>OLYMPUS EUS |
|--------------------|-------------------------------------------------------------------|
| Common Usual Name: | Endoscope channel accessory |

Classification Name: Endoscopic and accessories

#### 3. Establishment Registration Number

STERIS Corporation 5960 Heisley Rd. Mentor, Ohio 44060 Registration number: 1527821

US Endoscopy 5976 Heisley Road Mentor, Ohio 44060 Registration number: 1528319

{5}------------------------------------------------

#### 4. Device Classification

Class: Classification Number: Classification Panel: FDA Review Product Code: II 21 CFR 876.1500 Gastroenterology/Urology ODC, FDF

#### ട. Predicate Devices

DEFENDO Single Use Valve Kit AW/S Valves – 2pc OLYMPUS EUS K240098

#### 6. Device Description

The DEFENDO EUS Air/Water Valve and the DEFENDO EUS Suction Valve are accessories to an echoendoscope.

The EUS Air/Water valve allows the end user to control air or CO2 insufflation down the endoscope's accessory channel, control water used to wash the lens of the endoscope and insufflate a balloon at the distal end of the echoendoscope

The DEFENDO EUS Suction valve allows the user to control suction through the echoendoscope's accessory channel and suction to the balloon at the distal end of the echoendoscope.

Both devices are single-use devices, supplied sterile.

#### 7. Intended Use/Indications for Use

The DEFENDO EUS Air/Water Valve is intended to be used to control the air/water function of an endoscope during a GI endoscopic procedure.

The DEFENDO EUS Suction Valve is intended to be used to control the suction function of an endoscope during a GI endoscopic procedure.

#### 8. Device Comparison Table

The DEFENDO Single Use Valve Kit AW/S Valves – 2pc for OLYMPUS EUS are identical in design to the predicate and have the same intended use. The shelf life of the predicate device is 1 year while the subject device has a shelf life of 3 years (see comparison table below).

{6}------------------------------------------------

| Features | DEFENDO Single Use Valve Kit AW/S Valves – 2-pc for OLYMPUS EUS K240098 (Predicate Device) | DEFENDO Single Use Valve Kit AW/S Valves - 2-pc for OLYMPUS EUS (Proposed Device) | Comparison |
|------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended Use | The DEFENDO EUS Air/Water Valve is intended to be used to control the air/water function on an endoscope during a GI endoscopic procedure.<br><br>The DEFENDO EUS Suction Valve is intended to be used to control the suction function on an endoscope during a GI endoscopic procedure. | The DEFENDO EUS Air/Water Valve is intended to be used to control the air/water function on an endoscope during a GI endoscopic procedure.<br><br>The DEFENDO EUS Suction Valve is intended to be used to control the suction function on an endoscope during a GI endoscopic procedure. | Identical |
| Construction: | Air/Water Valve | | |
| | Stem, Gaskets, Spring Guide, Spring(s), and Endcap with Skirt<br><br># of Gaskets: 9<br># of Springs: 2 | Stem, Gaskets, Spring Guide, Spring(s), and Endcap with Skirt<br><br># of Gaskets: 9<br># of Springs: 2 | Identical |
| | Suction Valve | | |
| | Stem, Spring Guide, Spring(s), Endcap with Skirt, and Stainless-Steel Collar<br><br># of gaskets: 4<br># of springs: 2 | Stem, Spring Guide, Spring(s), Endcap with Skirt, and Stainless-Steel Collar<br><br># of gaskets: 4<br># of springs: 2 | Identical |
| Sterile/ Non-sterile | Sterile | Sterile | Identical |
| Sterilization Method | EtO | EtO | Identical |
| Sterilization Assurance Level | 10-6 | 10-6 | Identical |
| Usage | Single-Use | Single-Use | Identical |
| Materials: | Air/Water Valve | | |
| | Cap: PC-ABS<br>Spring(s): Stainless-Steel<br>Valve Stem: Top Half – Stainless-Steel / Bottom Half - PC-ABS<br>Spring Guide: PC-ABS<br>Gaskets: TPE<br>Skirt: TPE<br>Endcap: PC-ABS | | Identical |
| | Suction Valve | | |
| | Cap: PC-ABS<br>Spring(s): Stainless – Steel<br>Center Valve stem: Stainless-Steel<br>Offset Valve Stem: Ultem Plastic<br>Spring Guide: PC-ABS<br>Gaskets: TPE<br>Skirt: TPE<br>Endcap: Ultem<br>Cap Insert: Brass<br>Metal collar: Stainless-Steel | | Identical |
| | Cap: PC-ABS<br>Spring(s): Stainless-<br>Steel<br>Valve Stem: Top Half - Stainless-Steel / Bottom Half - PC-ABS<br>Spring Guide: PC-ABS<br>Gaskets: TPE<br>Skirt: TPE<br>Endcap: PC-ABS | | |
| | Cap: PC-ABS<br>Spring(s): Stainless – Steel<br>Center Valve stem: Stainless-Steel<br>Offset Valve Stem: Ultem Plastic<br>Spring Guide: PC-ABS<br>Gaskets: TPE<br>Skirt: TPE<br>Endcap: Ultem<br>Cap Insert: Brass<br>Metal collar: Stainless-Steel | | |
| Device<br>Dimensions<br>(lengths/widths) | Air/Water Valve: | | Identical |
| | Overall Length: 46 mm<br>Endcap Overmold Diameter: 11.25 mm | | |
| | Suction Valve: | | Identical |
| | Overall Length: 33 mm<br>Stem Diameter: 3.8 mm | | |
| | Overall Length: 46 mm<br>Endcap Overmold Diameter: 11.25 mm | | |
| | Overall Length: 33 mm<br>Stem Diameter: 3.8 mm | | |
| Target<br>Population | Patients undergoing an endoscopic procedure | Patients undergoing an endoscopic procedure | Identical |
| Energy Used/Delivered | None | None | Identical |
| Compatible Endoscopes | Olympus endoscope with a balloon channel | Olympus endoscope with a balloon channel | Identical |
| Packaging | Sealed thermoform tray | Sealed thermoform tray | Identical |
| *Shelf Life | 1 year shelf life | 3 year shelf life | Similar:<br>The DEFENDO<br>Single Use Valve<br>Kit AW/S Valves<br>– 2pc OLYMPUS<br>EUS has passed 3<br>year (accelerated)<br>age testing and<br>the device<br>functions as<br>intended. |

{7}------------------------------------------------

{8}------------------------------------------------

{9}------------------------------------------------

#### 9. Summary of Non-Clinical Performance Testing

(*Identical testing was conducted on both the predicate (cleared) 1 year version of the device and proposed 3 year shelf life version of the device. The three year shelf life summary is below.)

| Testing | Acceptance Criteria | Results |
|--------------------|---------------------------------------------------------------------------------------------------------------------------|---------|
| Air/Water Valve | | |
| Leakage | Valve shall not continuously leak<br>water | Pass |
| Insertion | No damage shall occur to either the<br>valve or the endoscope during<br>insertion | Pass |
| Valve - Stationary | Valve shall remain in place on the<br>endoscope after being fully seated | Pass |
| Flow | Minimum flows of predetermined<br>levels of each air and CO2 shall be<br>demonstrated | Pass |
| Flow | Minimum flow of predetermined<br>rates of water shall be demonstrated<br>during flow of each air and CO2 | Pass |
| Flow | Minimum flow of predetermined<br>rates of water shall fill the balloon<br>during flow of each air and CO2 | Pass |
| Tensile Strength | Spring compression force shall fall<br>within predetermined range in Stage<br>1 compression | Pass |
| Tensile Strength | Spring compression force shall fall<br>within predetermined range in Stage<br>2 compression | Pass |
| Cap - Torque | Torque force shall be above a<br>predetermined threshold to ensure no<br>separation of cap from the valve stem<br>occurs. | Pass |

Non-clinical testing consisted of the following:

{10}------------------------------------------------

| Testing | Acceptance Criteria | Results |
|--------------------|---------------------------------------------------------------------------------------------------------------------------|---------|
| Suction Valve | | |
| Leakage | Valve shall not continuously leak<br>water | Pass |
| Insertion | No damage shall occur to either the<br>valve or the endoscope during<br>insertion. | Pass |
| Insertion | The valve must not be able to be<br>inserted incorrectly into EUS scope<br>suction port. | Pass |
| Valve - Stationary | Valve shall remain in place on the<br>endoscope after being fully seated | Pass |
| Tensile Strength | Spring compression force shall fall<br>within predetermined range in Stage<br>1 compression | Pass |
| Tensile Strength | Spring compression force shall fall<br>within predetermined range in Stage<br>2 compression | Pass |
| Cap - Torque | Torque force shall be above a<br>predetermined threshold to ensure no<br>separation of cap from the valve stem<br>occurs. | Pass |

| Testing | Acceptance Criteria | Results |
|---------------------------------|------------------------------------------------------------|---------|
| Packaging | | |
| Pouch Seal – Tensile<br>Testing | Force to open sealed pouch shall be<br>0.57 lbs or greater | Pass |

#### 10. Conclusion

Based on the intended use, technological characteristics, and non-clinical performance data, the subject device is as safe, and effective as the predicate. The differences between the proposed and predicate devices include extension of shelf life and additional statements in the Instructions for Use.

The non-clinical testing for the extension in shelf life from one year to three years demonstrates the proposed change is substantially equivalent to the predicate.

The additional statements in the Instructions for Use do not raise any new concerns of safety and effectiveness.