STELLARTECH COAGULATION SYSTEM (MODELS 1100C-115 & 1100C-230)

K023765 · Stellartech Research Corp. · GEI · Nov 29, 2002 · General, Plastic Surgery

Device Facts

• Record ID: K023765
• Device Name: STELLARTECH COAGULATION SYSTEM (MODELS 1100C-115 & 1100C-230)
• Applicant: Stellartech Research Corp.
• Product Code: GEI · General, Plastic Surgery
• Decision Date: Nov 29, 2002
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 878.4400
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Stellartech Coagulation System is indicated for use in the coagulation of bleeding and non-bleeding sites in the gastrointestinal tract including but not limited to, the esophagus. Indications include Esophageal Ulcers, Mallory-Weiss tears, Arteriovenous Malformations, Angiomata, Barrett's Esophagus, Dieulafoy Lesions, and Angiodysplasia.

Device Story

Stellartech Coagulation System comprises a radiofrequency (RF) generator, probe connection module, coagulation probe, and optional footswitch. Device delivers RF energy to GI tract tissue to achieve coagulation of bleeding or non-bleeding sites. Operated by physicians in clinical settings. Probe connects to module, which connects to generator. Output is controlled RF energy for tissue coagulation. Benefits include management of specific GI lesions like ulcers, tears, and vascular malformations.

Clinical Evidence

No clinical data provided; substantial equivalence is based on design, principles of operation, and materials compared to legally marketed predicate devices.

Technological Characteristics

Electrosurgical unit consisting of an RF generator, probe connection module, and coagulation probe. Operates via radiofrequency energy for tissue coagulation. System components are connected via cables. Class II device (21 CFR 878.4400).

Indications for Use

Indicated for coagulation of bleeding and non-bleeding GI tract sites, including esophagus. Conditions include esophageal ulcers, Mallory-Weiss tears, AVMs, angiomata, Barrett's esophagus, Dieulafoy lesions, and angiodysplasia. Prescription use only.

Regulatory Classification

Identification

An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.

Predicate Devices

• Stellartech Radiofrequency Generator Model 1025A-115 and Model 1025A-230 (K994173)
• ArthroCare Electrosurgery System Generator (K971532)
• Valleylab Force 2 Electrosurgical Generator (K921884)
• RadioTherapeutics RF-2000 Radiofrequency Generator (K981672)
• ArthroCare Electrosurgery System Probe (K971532)
• Ximed Balloon Electrosurgical Probe/Device (K943014)
• Boston Scientific Microvasive Gold Probe (K970278)
• Bronchus Bronchial Catheter (K980046)
• C.R. Bard Eliminator Balloon Dilator (K940965)
• Hobbs Medical Dilation Balloon Catheter (K834413)
• Boston Scientific Microvasive Rigiflex ABD Achalasia Balloon Dilator (K number unknown)

Submission Summary (Full Text)

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# A. Name of Device

# 510(k) Safety Summary

- KO23765
- Trade Name: Stellartech Coagulation System .

# NOV 2 9 2002

- Common Name: Electrosurgical Unit and Accessories .
- Classification Name: Device, Electrosurgical Cutting and Coagulation and Accessories . (21 CFR 878.4400)

## B. Predicate Devices

| Device | Premarket Notification |
|-----------------------------------------------------------------------------|------------------------|
| Stellartech Radiofrequency Generator Model<br>1025A-115 and Model 1025A-230 | K994173, 01/20/00 |
| ArthroCare Electrosurgery System Generator | K971532, 07/23/99 |
| Valleylab Force 2 Electrosurgical Generator | K921884, 12/15/92 |
| RadioTherapeutics RF-2000 Radiofrequency<br>Generator | K981672, 07/17/98 |
| ArthroCare Electrosurgery System Probe | K971532, 07/23/99 |
| Ximed Balloon Electrosurgical Probe/Device | K943014, 03/11/96 |
| Boston Scientific Microvasive Gold Probe | K970278, 04/11/97 |
| Bronchus Bronchial Catheter | K980046, 05/01/98 |
| C.R. Bard Eliminator Balloon Dilator | K940965, 05/20/94 |
| Hobbs Medical Dilation Balloon Catheter | K834413, 05/22/84 |
| Boston Scientific Microvasive Rigiflex ABD<br>Achalasia Balloon Dilator | K number unknown |

### C. Device Description:

The Stellartech Coagulation System consists of the following components.

- Stellartech Coagulation Generator .
- Stellartech Coagulation Probe Connection Module ●
- Stellartech Coagulation Probe .
- Optional Stellartech Footswitch. .

The proximal end of the Stellartech Coagulation Probe connects to the Stellartech Coagulation Probe Connection Module. The proximal end of the Stellartech Coagulation Probe Connection Module cable connects to the Stellartech Coagulation Generator.

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### Indicated Use D.

The Stellartech Coagulation System is indicated for use in the coagulation of bleeding and non-bleeding sites in the gastrointestinal tract including but not limited to, the esophagus. Indications include Esophageal Ulcers, Mallory-Weiss tears, Arteriovenous Malformations, Angiomata, Barrett's Esophagus, Dieulafoy Lesions, and Angiodysplasia.

### E. Technical characteristics

The technological characteristics of the Stellartech Coagulation System are substantially equivalent to those of the above listed predicate devices.

### F. Summary

By virtue of design, principles of operation, materials and intended use, the Stellartech Coagulation System is substantially equivalent to devices currently marketed in the United States.

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# DEPARTMENT OF HEALTH & HUMAN SERVICES

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Stellartech Research Corporation James R. Santos Senior Quality Engineer 1346 Bordeaux Drive Sunnyvale, California 94089

Re: K023765

Trade/Device Name: Stellartech Coagulation System Regulation Number: 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: Class II Product Code: GEI Dated: November 11, 2002 Received: November 12, 2002

Dear Mr. Santos:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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 requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the

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Page 2 - Mr. James R. Santos

quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Muriam C. Provost

for Celia M. Witten, Ph.D., MD Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) NUMBER (IF KNOWN):

DEVICE NAME:

Stellartech Coagulation System

INDICATIONS FOR USE:

The Stellartech Coagulation System is indicated for use in the coagulation of bleeding and non-bleeding sites in the gastrointestinal tract including but not limited to, the esophagus. Indications include Esophageal Ulcers, Mallory-Weiss tears, Arteriovenous Malformations, Angiomata, Barrett's Esophagus, Dieulafoy Lesions, and Angiodysplasia.

K02376

Muriam C. Parrott

(Division Sign-Off) Division of General, Restorative and Neurological Devices

510(k) Number K623765

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use | (Per 21 CFR 801.109)

OR

Over-The-Counter-Use