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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AOMORI OLYMPUS CO., LTD. SINGLE USE BALLOON DILATOR V (WITH KNIFE)

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AOMORI OLYMPUS CO., LTD. SINGLE USE BALLOON DILATOR V (WITH KNIFE) Back to Search Results
Model Number BD-VC431Q-1840-25
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Hemorrhage/Bleeding (1888); Pancreatitis (4481); Unspecified Hepatic or Biliary Problem (4493)
Event Date 05/01/2021
Event Type  Injury  
Manufacturer Narrative
Since the literature described "stone master v", the "bd-vc431q-1840-25" was selected as a representative product with the largest number of shipments in the region and during the study period. The suspect device has not been returned to olympus for evaluation. The investigation is in process. Once the investigation has been completed, a supplemental report will be submitted with device evaluation results.
 
Event Description
Olympus reviewed the following literature titled "risk factors for perforation during endoscopic papillary large balloon dilation and bile duct stone removal. " this retrospective study aimed to investigate the risk factors for perforation during eplbd+ stone removal. A total of 310 patients with a median age of 79 years were included. Perforation occurred in five patients (1. 6%). Multivariate analysis indicated that no surrounding pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8. 3%, p
=
. 011, odds ratio: 12. 7 [95% confidence interval: 1. 8¿90. 5]). No significant difference was found between the over-dilation and non-over-dilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. The perforation rate in patients with no surrounding pancreas + overdilation was 16. 7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. This study concluded that the eplbd + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas. Type of adverse events/number of patients: perforation - 5 patients. Overdilation group: pancreatitis - 4 patients, bleeding - 6 patients, cholangitis - 1 patient. Non-overdilation group: pancreatitis - 3 patients, bleeding - 3 patients, cholangitis - 1 patient. The authors used many olympus devices and did not specify the olympus device used in relation to the adverse events experienced by the patients. Therefore, the olympus devices will be reported as follows: (b)(6): evis lucera duodenovideoscope jf-260v or tjf-260v; (b)(6): evis duodenovideoscope tjf-240; (b)(6): stonemasterv single use balloon dilator v (with knife) bd-vc431q-1840-25; (b)(6): gastrointestinal videoscope gif-1t240 evis; (b)(6): evis lucera small intestinal videoscope sif-q260, sif-y0004, sif-y0015; (b)(6): evis lucera elite small intestinal videoscope sif-h290s, sif-y0004, sif-y0015. This medwatch report is for patient identifier (b)(6). The perforations were determined to be not reportable as they were not caused by or contributed to the olympus device, per the author of the article. There is no report of any olympus device malfunction in any procedure described in this study.
 
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Brand NameSINGLE USE BALLOON DILATOR V (WITH KNIFE)
Type of DeviceBALLOON DILATOR
Manufacturer (Section D)
AOMORI OLYMPUS CO., LTD.
2-248-1 okkonoki
kuroishi-shi, aomori 036-0 357
JA 036-0357
Manufacturer Contact
masaharu hirose
2-248-1 okkonoki
kuroishi-shi, aomori 036-0-357
JA   036-0357
426422891
MDR Report Key15127004
MDR Text Key296846507
Report Number9614641-2022-00070
Device Sequence Number1
Product Code KNS
Combination Product (y/n)N
Reporter Country CodeJA
PMA/PMN Number
K150142
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Foreign,Literature,Health Professional,Company Representative
Reporter Occupation
Type of Report Initial
Report Date 07/28/2022
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/28/2022
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Model NumberBD-VC431Q-1840-25
Device Lot NumberUNKNOWN(LITERATURE)
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? No
Date Manufacturer Received07/03/2022
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 07/28/2022 Patient Sequence Number: 1
Treatment
CRE BALLOON DILATOR (BOSTON SCIENTIFIC CORP.); GIF-1T240, SN UNKNOWN; JF-260V, TJF-260V, TJF-240, SN UNKNOWN; MECHANICAL OR ELECTROHYDRAULIC LITHOTRIPSY; REN BILIARY BALLOON (KANEKA MEDIX CORP.); SIF-Q260, SIF-H290S, SIF-Y0004, SIF-Y0015
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