Cleared Traditional

K091495 - SINGLE USE 3-LUMEN EXTRACTION BALLOON V, MODEL V B-V233P-A,B-V233P-B,B-V433P-A,B-V433P-B, BV243Q-A, B-V243Q-B, B-V443Q-A

K091495 is an FDA 510(k) clearance for SINGLE USE 3-LUMEN EXTRACTION BALLOON V, manufactured by Olympus Medical Systems Corporation. The device is a Class 2 Gastroenterology & Urology device with product code LQR cleared through the Traditional 510(k) pathway after a 106-day FDA review.

K091495 · Olympus Medical Systems Corporation · Gastroenterology & Urology device
Download Printable Device Report (PDF)
Optimized for regulatory review, auditing and printing
Sep 2009
Decision
106d
Days
Class 2
Risk

K091495 is an FDA 510(k) clearance for the SINGLE USE 3-LUMEN EXTRACTION BALLOON V, MODEL V B-V233P-A,B-V233P-B,B-V433P-.... Classified as Dislodger, Stone, Biliary (product code LQR), Class II - Special Controls.

Submitted by Olympus Medical Systems Corporation (Center Valley, US). The FDA issued a Cleared decision on September 3, 2009 after a review of 106 days - within the typical 510(k) review window.

This device falls under the Gastroenterology & Urology FDA review panel, regulated under 21 CFR 876.5010 - the FDA gastroenterology and urology device framework. The Traditional 510(k) pathway establishes clearance through substantial equivalence to a legally marketed predicate device, without requiring clinical trial data.

Device pattern: Standard predicate-based submission. Standard predicate reliance. This clearance follows a standard predicate-based equivalence path within the Gastroenterology & Urology review framework, consistent with the majority of Class II 510(k) submissions.

View all Olympus Medical Systems Corporation devices

FDA 510(k) Submission Details - K091495

510(k) Number K091495 FDA.gov
FDA Decision Cleared Substantially Equivalent - Traditional 510(k) (SESE)
Date Received May 20, 2009
Decision Date September 03, 2009
Days to Decision 106 days
Submission Type Traditional
Review Panel Gastroenterology & Urology (GU)
Summary Summary PDF
Third-party Review No - reviewed directly by FDA
Combination Product No
PCCP Authorized No
Regulatory Context
Review time vs. panel average
25d faster than avg
Panel avg: 131d · This submission: 106d
Pathway characteristics
Predicate-based equivalence. No clinical trials required.

LQR Device Classification - Class 2, Special Controls

Product Code LQR Dislodger, Stone, Biliary
Device Class Class 2 - Special Controls
CFR Regulation 21 CFR 876.5010
What this classification means

Class II devices require demonstration of substantial equivalence to a legally marketed predicate device. This pathway does not require clinical trials - it relies on engineering equivalence and performance data. Most Gastroenterology & Urology devices follow this clearance model.

Regulatory Peers - LQR Dislodger, Stone, Biliary

All 33
Devices cleared under the same product code (LQR) and FDA review panel - the closest regulatory comparables to K091495.
Single Use Retrieval Nitinol Basket V
K170811 · Olympus Medical Systems Corp. · Nov 2017
NCompass Nitinol Stone Extractors
K173009 · Cook Incorporated · Nov 2017
RSH BILIARY STONE REMOVAL DEVICE
K131642 · Rsh, LLC · Aug 2013
SPYCATCH STONE RETRIEVAL BASKET
K071066 · Boston Scientific Corp · Jun 2007
LEMAITRE BILIARY CATHETER
K992941 · Vascutech, Inc. · Jan 2000
KARL STORZ TAKE-APART ROTATING GRASPING FORCEPS
K952149 · KARL STORZ Endoscopy-America, Inc. · Jun 1995