MAUDE Adverse Event Report: APOLLO ENDOSURGERY OVERSTITCH ENDOSCOPIC SUTURE SYSTEM; ENDOSCOPIC TISSUE APPROXIMATION DEVICE

Model Number	ESS-G02-160
Medical Device Problem Codes	Failure to Align (2522); Device-Device Incompatibility (2919); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/30/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Block h6: imdrf code a1702 captures the reportable event of failure to retrieve anchor.Imdrf code f2301 captures the reportable event of additional device required.
Event or Problem Description
It was reported that an overstitch ess was utilized during an endoscopic suture sculpt procedure on (b)(6) 2025, for the treatment of obesity and weight loss.During the procedure, the overstitch ess was unable to transfer the needle at exchange for multiple attempts which delayed the case 5 minutes.There appeared to be an alignment issue.The physician used forceps to grab the anchor and remove it from the needle driver.Once the anchor was removed, the physician was able to close the handle and remove the scope from the patient.The procedure was completed with another of the same device.No patient complications were reported as a result of the event.
Additional Manufacturer Narrative
Block h6: imdrf code a1702 captures the reportable event of failure to retrieve anchor.Imdrf code f2301 captures the reportable event of additional device required.Block h11: device evaluation summary: the overstitch ess was returned with the anchor exchange.Visual inspection identified that the working length was bent.This condition is most likely attributable to procedural factors, such as device handling and technique used by the physician (e.G., force applied during use), which may have resulted in the observed deformation.Microscopic evaluation confirmed that the anchor exchange successfully deployed, retrieved, and passed the anchor.The needle body was observed to be intact and not bent.Overall, aside from the bent working length, the device was in good condition and functioned as intended during testing.Due to insufficient objective evidence, the reported events of needle shaft failure to align, anchor exchange failure to retrieve anchor, and anchor exchange failure to pass anchor could not be confirmed.The reported event of prolonged episode of care and additional device required occurred during the procedure; however, a definitive cause for these events could not be established based on the available information.Based on the review of all compiled information, the most probable cause is determined to be device problem excluded.
Event or Problem Description
It was reported that an overstitch ess was utilized during an endoscopic suture sculpt procedure on (b)(6) 2025, for the treatment of obesity and weight loss.During the procedure, the overstitch ess was unable to transfer the needle at exchange for multiple attempts which delayed the case 5 minutes.There appeared to be an alignment issue.The physician used forceps to grab the anchor and remove it from the needle driver.Once the anchor was removed, the physician was able to close the handle and remove the scope from the patient.The procedure was completed with another of the same device.No patient complications were reported as a result of the event.

• Brand Name: OVERSTITCH ENDOSCOPIC SUTURE SYSTEM
• Common Device Name: ENDOSCOPIC TISSUE APPROXIMATION DEVICE
• Manufacturer (Section D): APOLLO ENDOSURGERY; 1120 s. capital of texas hwy; bldg 1 suite 300; austin TX 78746
• Manufacturer (Section G): VIANT MEDICAL INC; 5079 33rd street; grand rapids MI 49512
• Manufacturer Contact: christina lam ; 300 boston scientific way; marlborough, MA 01752 ; 9145716918
• MDR Report Key: 23882958
• Report Number: 3005099803-2025-06858
• Device Sequence Number: 9622613
• Product Code: OCW
• UDI-Device Identifier: 20811955020661
• UDI-Public: (01)20811955020661(11)250611(17)280531(10)2025060017
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: K181141
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 02/24/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: ESS-G02-160
• Device Catalogue Number: ESS-G02-160
• Device Lot Number: 2025060017
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/03/2025
• Supplement Date Received by Manufacturer: 01/27/2026
• Initial Report FDA Received Date: 12/23/2025
• Supplement Report FDA Received Date: 02/24/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/11/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 48 YR
• Patient Sex: Female
• Patient Weight: 113 KG