← Product Code [FDS](/submissions/GU/subpart-b%E2%80%94diagnostic-devices/FDS) · K260573

# EvoEndo Single-Use Endoscopy System (K260573)

_EvoEndo, Inc. · FDS · Apr 21, 2026 · Gastroenterology, Urology · SESE_

**Canonical URL:** https://fda.innolitics.com/submissions/GU/subpart-b%E2%80%94diagnostic-devices/FDS/K260573

## Device Facts

- **Applicant:** EvoEndo, Inc.
- **Product Code:** [FDS](/submissions/GU/subpart-b%E2%80%94diagnostic-devices/FDS.md)
- **Decision Date:** Apr 21, 2026
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 876.1500
- **Device Class:** Class 2
- **Review Panel:** Gastroenterology, Urology
- **Attributes:** Therapeutic, Pediatric

## Indications for Use

The EvoEndo Model LE Gastroscope is intended for the visualization of the upper digestive tract in adults and pediatric patients, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb. The gastroscope is a sterile single-use device and can be inserted orally or transnasally. The 110 cm gastroscope is intended to be used in adult and pediatric populations. The 85 cm gastroscope is intended to be used in the pediatric population. The EvoEndo Controller is intended for use with an EvoEndo Endoscope for endoscopic diagnosis, treatment, and video observation.

## Device Story

EvoEndo Single-Use Endoscopy System consists of a sterile, single-use gastroscope, a reusable video cable, and a controller. The gastroscope features an HD camera at the distal end and is inserted orally or transnasally to visualize the upper digestive tract. The controller processes video signals from the gastroscope and outputs them to a medical-grade monitor via HDMI. The system is used by clinicians for endoscopic diagnosis, treatment, and observation. The current submission introduces a labeling change to transition the video cable from single-use to reusable, supported by cleaning and disinfection validation.

## Clinical Evidence

No clinical data was required or provided. The submission relies on cleaning and disinfection validation for the reusable video cable component.

## Technological Characteristics

System includes a single-use gastroscope (Pebax shaft, 3.5mm OD, 2.0mm working channel, 4-way steering) and a reusable video cable. Controller is aluminum-housed. Connectivity via HDMI/USB 3.0. Sterilization of endoscope via ethylene oxide (EO). Firmware provides image enhancement (gamma correction), freeze, and white-balance functions.

## Regulatory 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

- EvoEndo Single-Use Endoscopy System ([K251708](/device/K251708.md))

## Submission Summary (Full Text)

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FDA U.S. FOOD & DRUG ADMINISTRATION

April 21, 2026

EvoEndo, Inc.
% Keira Jessop
Regulatory Affairs Consultant
AlvaMed, Inc.
935 Great Plain Ave.
Unit 166
Needham, Massachusetts 02492

Re: K260573
Trade/Device Name: EvoEndo Single-Use Endoscopy System
Regulation Number: 21 CFR 876.1500
Regulation Name: Endoscope And Accessories
Regulatory Class: Class II
Product Code: FDS, FET
Dated: February 19, 2026
Received: February 20, 2026

Dear Keira Jessop:

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.

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"

U.S. Food & Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
www.fda.gov

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K260573 - Keira Jessop
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(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 Management System Regulation (QMSR) (21 CFR Part 820), which includes, but is not limited to, ISO 13485 clause 7.3 (Design controls), ISO 13485 clause 8.3 (Nonconforming product), ISO 13485 clause 8.5.2 (Corrective action), and ISO 13485 clause 8.5.3 (Preventative action). Please note that regardless of whether a change requires premarket review, the QMSR requires device manufacturers to review and approve changes to device design and production (ISO 13485 clause 7.3 and ISO 13485 clause 7.5) and document changes and approvals in the Medical Device File (ISO 13485 clause 4.2.3).

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 (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-reporting-combination-products); good manufacturing practice requirements as set forth in the Quality Management System Regulation (QMSR) (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-devices/device-advice-comprehensive-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-devices/medical-device-safety/medical-device-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-devices/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-advice-comprehensive-regulatory-assistance/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).

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K260573 - Keira Jessop
Page 3

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

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FORM FDA 3881 (8/23)
Page 1 of 1
PSC Publishing Services (301) 443-6740
EF

|  DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Indications for Use | Form Approved: OMB No. 0910-0120 Expiration Date: 07/31/2026 See PRA Statement below.  |
| --- | --- |
|  510(k) Number (if known) K260573  |   |
|  Device Name EvoEndo Single-Use Endoscopy System  |   |
|  Indications for Use (Describe) The EvoEndo Model LE Gastroscope is intended for the visualization of the upper digestive tract in adults and pediatric patients, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb. The gastroscope is a sterile single-use device and can be inserted orally or transnasally. The 110 cm gastroscope is intended to be used in adult and pediatric populations. The 85 cm gastroscope is intended to be used in the pediatric population. The EvoEndo Controller is intended for use with an EvoEndo Endoscope for endoscopic diagnosis, treatment, and video observation.  |   |
|  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."  |   |

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K260573
Page 1 of 6

510(k) Summary
K260573

## 1.1 Name and Address of Submitter

Paul Imaoka
EvoEndo, Inc.
888 East Belvidere Road
Suite 212
Grayslake, IL 60030
(303) 223-7445
pimaoka@evoendo.com

## 1.2 Correspondent/Primary Contact Person

Keira Jessop, M.S., RAC
Regulatory Affairs Consultant
AlvaMed, Inc.
935 Great Plain Avenue, Unit 166
Needham, MA 02492 USA
kjessop@alvamed.com
Phone: +1 (888) 331-3485 Fax: +1 (617) 249-0955

## 1.3 Submission Information

Date Summary Prepared: April 17, 2026

|  Subject Device: | Trade/Device Name: | EvoEndo Single-Use Endoscopy System  |
| --- | --- | --- |
|   | Manufacturer: | EvoEndo, Inc.  |
|   | Common Name: | Gastroscope and accessories, flexible/rigid  |
|   |  | Endoscopic video imaging system/Component, Gastroenterology-Urology  |
|   | Regulation Number: | 21 CFR 876.1500  |
|   | Regulation Name: | Endoscope and accessories  |
|   | Regulation Class | Class II  |
|   | Product Code: | FDS, FET  |
|   | Review Panel: | Gastroenterology/Urology  |

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**Predicate Device:** Clearance: K251708
**Trade/Device Name:** EvoEndo Single-Use Endoscopy System

**Manufacturer:** EvoEndo, Inc.
**Regulation Number:** 21 CFR 876.1500
**Regulation Name:** Endoscope and accessories
**Regulation Class:** Class II

## Valid Predicate Discussion

EvoEndo Single-Use Endoscopy System was selected as the valid predicate device used to support the 510(k) submission because it was cleared using well-established methods and this submission is to address design changes to the predicate device. After conducting a search on the Manufacturer and User Facility Device Experience (MAUDE) Database, Medical Device Reporting (MDR), MedSun Reports Database, Medical Device Safety and CBER Safety & Availability (Biologics) and Recall Database websites it was confirmed that there are no known unmitigated use-related or design safety issues and the predicate device has not been subject to a design-related recall.

Table 1: Valid Predicate Device

|  Valid Predicate Device | A - Well established methods | B - Meets or exceeds expected predicate performance | C - Unmitigated use-related or design-related safety issues | D – Associated design-related recall  |
| --- | --- | --- | --- | --- |
|  EvoEndo Single-Use Endoscopy System | Used relevant methods that were published in the public domain. | History of Safe use, established due to duration of device on the market | No known unmitigated use-related or design related safety issues | No design-related recall identified  |

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## 1.4 Device Description

The EvoEndo Endoscopy System is comprised of three regulated components:

- EvoEndo Model LE Single-Use Gastroscope (hereafter referred to as the EvoEndo Endoscope)
- EvoEndo Reusable Video Cable (hereafter referred to as the Video Cable)
- EvoEndo Controller (hereafter referred to as the Controller)

The EvoEndo Endoscope is a sterile, single-use gastroscope intended to perform oral or transnasal diagnostic endoscopy in adult and pediatric patients. The EvoEndo Endoscope is ethylene oxide (EO) sterilized and is comprised of:

- Handle
- Umbilical Bundle that includes air, water, and suction lines, as well as the video connector
- Endoscope shaft with HD Camera

The Controller of the EvoEndo Endoscopy System translates the images or video captured by the camera at the distal end of the EvoEndo Endoscope to a monitor via an HDMI cable.

## 1.5 Indications for Use

The EvoEndo Model LE Gastroscope is intended for the visualization of the upper digestive tract in adults and pediatric patients, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb. The gastroscope is a sterile single-use device and can be inserted orally or transnasally. The 110 cm gastroscope is intended to be used in adult and pediatric populations. The 85 cm gastroscope is intended to be used in the pediatric population.

The EvoEndo Controller is intended for use with an EvoEndo Endoscope for endoscopic diagnosis, treatment, and video observation.

## 1.6 Summary of Technological Characteristics

The following table provides an overview of general technological characteristics in comparison to the predicate device.

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Table 2: Comparison of Predicate Device and Subject Device

|   | Subject Device | Predicate Device  |
| --- | --- | --- |
|  510(k) Number | K260573 | K251708  |
|  Sponsor | EvoEndo, Inc | EvoEndo, Inc  |
|  Device Name | EvoEndo Endoscopy System | EvoEndo Endoscopy System  |
|  Product Code | FDS, FET | FDS, FET  |
|  Indications for Use | The EvoEndo Model LE Gastroscope is intended for the visualization of the upper digestive tract in adults and pediatric patients, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb. The gastroscope is a sterile single-use device and can be inserted orally or transnasally. The 110 cm gastroscope is intended to be used in adult and pediatric populations. The 85 cm gastroscope is intended to be used in the pediatric population. The EvoEndo Controller is intended for use with an EvoEndo Endoscope for endoscopic diagnosis, treatment, and video observation. | The EvoEndo Model LE Gastroscope is intended for the visualization of the upper digestive tract in adults and pediatric patients, specifically for the observation, diagnosis, and endoscopic treatment of the esophagus, stomach, and duodenal bulb. The gastroscope is a sterile single-use device and can be inserted orally or transnasally. The 110 cm gastroscope is intended to be used in adult and pediatric populations. The 85 cm gastroscope is intended to be used in the pediatric population. The EvoEndo Controller is intended for use with an EvoEndo Endoscope for endoscopic diagnosis, treatment, and video observation.  |
|  Endoscope Outer Diameter | 3.5mm | 3.5mm  |
|  Working Channel Diameter | 2.0mm | 2.0mm  |
|  Working Length | 110cm and 85cm | 110cm and 85cm  |
|  Field of View | 120° | 120°  |
|  Steering Method | 4-way | 4-way  |
|  Maximum Bending Angle | Up 210°
Down 90°
Left 180°
Right 180° | Up 210°
Down 90°
Left 180°
Right 180°  |

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|   | Subject Device | Predicate Device  |
| --- | --- | --- |
|  Shaft Design | Multi-lumen braid reinforced Pebax | Multi-lumen extrusion made of Pebax  |
|  Air, Water, Suction (AWS) Functionality | Yes | Yes  |
|  Single-Use or Reusable | Endoscope: Single use
Video cable: Reusable | Endoscope: Single use
Video cable: Single use  |
|  Video Inputs | Ferric HDMI Cable & USB 3.0 Cable | Ferric HDMI Cable & USB 3.0 Cable  |
|  Monitor Compatibility | Medical grade monitor (27-inch, 1080p HD resolution recommended) | Medical grade monitor (27-inch, 1080p HD resolution recommended)  |
|  Illumination Technology | Located in EvoEndo Endoscope | Located in EvoEndo Endoscope  |
|  Electrical Specifications Input Voltage | 100 – 240 VAC, 50-60 Hz
0.5A | 100 – 240 VAC, 50-60 Hz
0.5A  |
|  U.S. Power Cord Specifications | 115 VAC
Length – 1.5 meters Voltage
Rating – 240 VAC
Current Rating – 12 A
Connector Type – Horizontal | 115 VAC
Length – 1.5 meters Voltage
Rating – 240 VAC
Current Rating – 12 A
Connector Type – Horizontal  |
|  Packaging | Plastic card with a HDPE Tube over device shaft sealed in a Tyvek pouch | Plastic card with a HDPE Tube over device shaft sealed in a Tyvek pouch  |
|  Controller Physical Specifications  |   |   |
|  Material | Aluminum | Aluminum  |
|  Height | 6.0 cm | 6.0 cm  |
|  Weight | 15.0 cm | 15.0 cm  |
|  Depth | 21.5 cm | 21.5 cm  |
|  Firmware  |   |   |
|  Controller Firmware | Options for “Image enhance” (gamma correction), user-programmable function, image freeze, and white-balance reset. | Options for “Image enhance” (gamma correction), user-programmable function, image freeze, and white-balance reset.  |

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## 1.7 Performance Testing Summary

This submission is for a labeling change (single-use verses reusable) for the video cable component of the system. No design or manufacturing changes have been made to subject device when compared to the predicate, therefore no performance testing was conducted on the subject device for this submission. A cleaning and disinfection validation was conducted for the video cable to support the labeling change.

## 1.8 Conclusion

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807 and based on the information provided in this premarket notification that it can be concluded that the subject device is substantially equivalent with predicate device.

---

**Source:** [https://fda.innolitics.com/submissions/GU/subpart-b%E2%80%94diagnostic-devices/FDS/K260573](https://fda.innolitics.com/submissions/GU/subpart-b%E2%80%94diagnostic-devices/FDS/K260573)

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