Home India Ministry of Health and Family Welfare Classification of Medical Device pertaining to Gastroenterol...
Date: 2021-09-27 Category: Not Applicable State: Union Government Country: India

Classification of Medical Device pertaining to Gastroenterology under the provisions of Medical Devices Rules, 2017

Issued by Ministry of Health and Family Welfare · Central Drugs Standard Control Organization

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Executive Summary & Key Takeaways

What it means

  • This gazette notification provides a classification of medical devices pertaining to gastroenterology based on their risk class (A, B, C, or D) as determined by the Drugs Controller General (India).

Key Changes

  • The notification lists 153 medical devices used in gastroenterology and assigns a risk class to each.
  • Risk Class A: Includes devices like closed-ended intestinal ostomy bags, enema tips and tubes, intestinal stoma shields, laparoscopic grasping forceps (Non sterile), nasogastric tube holders (non-invasive, non-sterile/sterile), rectal/colonic lavage support kit, rectoscope/proctoscope handle and handle end-cap, intestinal ostomy bag anti-adhesion device, intestinal ostomy kit, gravity enema set.
  • Risk Class B: Includes devices like absorbent enteric stomal dressing, anal fistula circular cutter, anoscope (reusable and single-use), barium enema catheter, biliary manometric catheter, catheter-balloon inflator (reprocessed, reusable and single-use), cholangiopancreatography catheter (reusable and single-use), colonic endoscopy cuff, colonic lavage kit, surgical, colonoscope positioning sleeve, colonoscope stiffener, colorectal sizer, common bile duct dilator, endoscope tissue removal cap, endoscopic biopsy valve (sterile), endoscopic cutting stapler connector, endoscopic electrosurgical electrode/submucosal lift needle, endoscopic gastrointestinal stenosis dilator, endoscopic motorized cutting stapler (reusable and single-use), endoscopic needleless submucosal lift catheter, endoscopic overtube (reusable), endoscopic spray catheter, enteral feeding tube clearing kit, enteral tube extension (non-sterile and sterile), externally-propelled flexible video colonoscope, flexible fibreoptic/video endoscopes (various types), gastric tonometry catheter, gastrointestinal catheter/endoscope tracking system, gastrointestinal endoscopic clip applier, gastrointestinal endoscopic clip, short-term, gastrointestinal manometric catheter (electronic and non-electronic), gastrostomy tube Y-piece connector, gastro-urological director/probe/scoop, laparoscopic cholangiography catheter/needle, Laparoscopic grasping forceps (sterile), Laparoscopic swab forceps, Manual enema device, Manual enema device (reusable), Manual rectal irrigation system, Motorized laparoscopic forceps, Nasoenteral tube, Nasogastric tube holder (intranasal), Non-vascular catheter introduction set, Oesophageal temperature monitor, Percutaneous biliary biopsy procedure kit, Powered rectal/colostomy irrigation system, Proctoscope (reusable and single-use), Rectal speculum, Rectal suction biopsy system, Rectoscope (reusable and single-use), Rigid oesophagoscope, Rigid sigmoidoscope, Robotic surgical retractor, Self-propelled flexible video colonoscope, Spring-loaded pneumoperitoneum needle (reusable and single-use), Static magnetic anal plug, Stoma drainage catheter, TEM/TEO rectoscope (optical and video), Video capsule endoscopy system, Video capsule endoscopy system application computer assisted display, processing and analysis software, Video capsule endoscopy system capsule.
  • Risk Class C: Includes devices like anal fistula seton, bile duct prosthesis, colonic mucosa barrier dressing, duodenal bypass liner, duodenal-jejunal bypass liner, endoscopic electrosurgical biopsy/resection kit (full-thickness and partial-thickness), gastrointestinal anastomosis coupler, non-bioabsorbable, gastrointestinal endoscopic clip cutter/generator, gastrointestinal endoscopic clip, long-term, gastrojejunostomy tube, gastro-oesophageal antireflux prosthesis, gastrostomy aspiration system gravity set and stomach tube, gastrostomy button, gastrostomy T fastener, implantable gastric clamp, Implantable incontinence-control electrical stimulation system, Implantable peritoneal catheter holder, Intestinal splint, Paediatric-temperature nasogastric/orogastric tube, Partially-implantable abdominal port/catheter, Pharyngeal electrical stimulation catheter, Probiotic oropharyngeal mucosa dressing, Robotic electrosurgical instrument, bipolar, single-use, Stoma support implant, Thermal-regulation orogastric tube, Transenteric drainage tube, Pancreatic stent.
  • Risk Class D: Includes devices like Fistula-repair biomatrix implant, Gastrointestinal anastomosis coupler, bioabsorbable.

Impact Analysis

Manufacturers

  • Action Item: Conduct a gap analysis of current compliance status against the new classification and develop a plan to address any gaps.

Healthcare Providers

  • Action Item: Update procurement policies and training programs to reflect the new medical device classifications.

Patients

  • Action Item: No direct action required, but patient awareness programs can be conducted to explain the benefits of medical device regulations.

Regulatory Bodies

  • Action Item: Develop and implement updated regulatory guidelines and enforcement mechanisms for gastroenterology medical devices.

Key Entities Referenced

Drugs Controller General (India): The regulatory authority responsible for classifying medical devices and ensuring their safety and efficacy in India. Central Drugs Standard Control Organization (CDSCO): The national regulatory body for pharmaceuticals and medical devices in India, under the Directorate General of Health Services, Ministry of Health and Family Welfare.
Official Source Record View Original Source →
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Appendix A File No. 29/Misc./03/2020-DC (182) Drugs Controller General (India) Directorate General of Health Services Central Drugs Standard Control Organisation FDA Bhawan, Kotla Road, New Delhi Notice Classification of Medical Devices Pertaining to Gastroenterology Sr Risk Medical Device Name Intended Use No. Class To be placed over a continent enteric stoma (surgically-created artificial opening between the intestines and the body surface through which bodily Absorbent enteric stomal 1 waste is drained from the intestines) to protect it B dressing from harmful external influences, which includes absorbent materials intended to protect the surrounding skin from enteric fluids. To be intended for the circumferential resection of 2 Anal fistula circular cutter B tissue to treat simple anal fistula A sterile implantable cord intended to be placed through an anal fistula tract and tied outside the 3 Anal fistula seton C fistula, forming a loop around the anus, to allow drainage through the fistula for tissue healing. An endoscope with a rigid inserted portion intended 4 Anoscope, reusable for the visual examination and treatment of the anus B and rectum. A sterile endoscope with a rigid inserted portion 5 Anoscope, single-use intended for the visual examination and treatment of B the anus and rectum. A flexible tube designed to administer barium, a contrast medium, into the lower gastrointestinal tract 6 Barium enema catheter B by way of the rectum, for radiographic visualization of the area. An implantable artificial substitute for the tube-like 7 Bile duct prosthesis structure that carries bile from the gallbladder to the C duodenum. A sterile, non-electrical flexible tube intended to be Biliary manometric inserted into the biliary tree to measure pressures 8 B catheter within the ducts, especially to evaluate sphincter of Oddi function. Page 1 of 17A sterile device designed to manually inflate and regulate the pressure of a balloon catheter (e.g., by injecting and aspirating fluid or air within the Catheter-balloon inflator, 9 balloon), and to deflate the balloon during a medical B reprocessed procedure.It is typically used during angiography, angioplasty, gastrointestinal (GI), or sinuplasty procedures. A device designed to manually inflate and regulate Catheter-balloon inflator, the pressure of a balloon catheter (e.g., by injecting 10 B reusable and aspirating fluid or air within the balloon), and to deflate the balloon during a medical procedure. A sterile device designed to manually inflate and regulate the pressure of a balloon catheter (e.g., by Catheter-balloon inflator, 11 injecting and aspirating fluid or air within the B single-use balloon), and to deflate the balloon during a medical procedure. A flexible tube inserted through a flexible endoscope, after its placement in the duodenum via the oral cavity, for the endoscopic cannulation of the Cholangiopancreatography 12 gastrointestinal ductal system (i.e., the pancreatic, B catheter, reusable hepatic, and/or common bile ducts) during endoscopic retrograde cholangiopancreatography (ERCP). A flexible tube inserted through a flexible endoscope, after its placement in the duodenum via the oral cavity, intended for the endoscopic Cholangiopancreatography 13 cannulation of the gastrointestinal ductal system B catheter, single-use (i.e., the pancreatic, hepatic, and/or common bile ducts) during endoscopic retrograde cholangiopancreatography (ERCP). A non-sterile plastic pouch designed to be attached Closed-ended intestinal around a faecal stoma for use as a receptacle for 14 A ostomy bag, multiple-piece faeces following a colostomy [the stool (faeces) being generally well formed]. A non-sterile plastic pouch designed to be attached with an adhesive to the skin around a faecal stoma Closed-ended intestinal 15 and used as a receptacle for faeces following a A ostomy bag, one-piece colostomy [the stool (faeces) being generally well formed]. A sterile distal attachment to a flexible endoscope 16 Colonic endoscopy cuff intended to improve endoscopic control and bowel B visualization during colonic endoscopy. A collection of sterile devices intended to be used during open colorectal surgery (bowel resection) to irrigate the colon above (proximal to) the site of a 17 Colonic lavage kit, surgical B lesion/blockage, prior to surgical anastomosis, when preoperative preparation of the colon has not been possible, normally due to obstruction. Page 2 of 17A non-sterile solution/suspension intended to be introduced into the sigmoid/descending colon as an enema for the treatment of inflammatory bowel Colonic mucosa barrier 18 disease (e.g., ulcerative colitis). It is intended to C dressing create an adhesive physical barrier on the colonic mucosa to protect the mucosa from potentially harmful substances in the distal colon lumen A non-sterile endoscopic sheath with two inflatable Colonoscope positioning balloons designed to be mounted on a colonoscope 19 B sleeve to position and stabilize the endoscope within the large intestine of a patient. A dedicated stiff wire that is inserted into a flexible colonoscope to allow the physician to increase the 20 Colonoscope stiffener B stiffness of the colonoscope when extra rigidity is required during a colonoscopy. A hand-held manual surgical instrument designed to assess colon and/or rectal lumen diameter to aid the 21 Colorectal sizer selection of an appropriate size intraluminal stapler B (i. e, the stapler head) for bowel anastomosis following transection. A hand-held manual surgical instrument designed to 22 Common bile duct dilator dilate the common bile duct, i.e., the union of the B cystic and hepatic ducts. A non-sterile stent-like device with a valve designed to be implanted in the duodenum where it is 23 Duodenal bypass liner C intended to reduce duodenal nutrient absorption from food to facilitate obese patient weight loss. A sterile stent-like implant designed to function as an impermeable barrier in the duodenum and part of the jejunum for partially-digested food from the Duodenal-jejunal bypass 24 stomach (chyme) passing on its inside and C liner bile/digestive enzymes passing on its outside, intended to treat type 2 diabetes mellitus and obesity. A sterile plastic tube designed to be placed onto the distal end of an endoscope (e.g., oesophagoscope) Endoscope tissue removal 25 to facilitate the removal of coagulated blood/tissue B cap during electrosurgical treatment (e.g., for the treatment of Barrett’s oesophagus). A non-sterile device intended to be fitted to an endoscope biopsy port to enable access Endoscopic biopsy valve, 26 for/exchange of endoscopic devices while A non-sterile maintaining insufflation and minimizing leakage of biomaterial during an endoscopic procedure. A sterile device intended to be fitted to an endoscope biopsy port to enable access Endoscopic biopsy valve, 27 for/exchange of endoscopic devices while B sterile maintaining insufflation and minimizing leakage of biomaterial during an endoscopic procedure. Page 3 of 17A rod-like component of an endoscopic cutting Endoscopic cutting stapler 28 stapler intended to enable connection between the B connector stapler handpiece and the endpiece/loading unit. A collection of sterile devices, which includes an Endoscopic electrosurgical implantable haemostatic ligation clip, intended to be 29 biopsy/resection kit, full- used to obtain a full-thickness tissue biopsy and/or C thickness therapeutic resection of gastric, duodenal, colonic, and/or rectal tissue during an endoscopic procedure. A collection of devices designed to be inserted through a compatible endoscope to obtain a Endoscopic electrosurgical mucosal tissue biopsy and/or therapeutic resection 30 biopsy/resection kit, C of upper gastrointestinal (GI) tract tissue, typically partial-thickness during endoscopic retrograde cholangiopancreatography (ERCP) procedures. A sterile, invasive, endoscopic device intended to Endoscopic electrosurgical deliver both: 1) a submucosal lifting solution; and 2) 31 electrode/submucosal lift an electrosurgical current in a monopolar B needle configuration (i.e., with a return electrode) to tissues for cutting/coagulation. A sterile invasive device intended to be used to Endoscopic dilate or expand a narrowing lesion (e.g., 32 gastrointestinal stenosis oesophageal stricture, stenosis) in the lumen of the B dilator gastrointestinal [GI] tract, under endoscopic visualization. A hand-held, battery-powered surgical instrument designed to be used during endoscopic surgical Endoscopic motorized 33 procedures for the expeditious transection and B cutting stapler, reusable resection of tissues and the creation of anastomoses. A sterile, hand-held, battery-powered surgical instrument designed to be used during endoscopic Endoscopic motorized 34 surgical procedures for the expeditious transection B cutting stapler, single-use and resection of tissues and the creation of anastomoses. A sterile, flexible tube intended to non-invasively deliver a submucosal lifting solution into the Endoscopic needleless submucosa of the gastrointestinal tract through a 35 B submucosal lift catheter flexible endoscope during an endoscopic procedure (e.g., gastroscopy, colonoscopy) to lift a lesion, typically for subsequent excision. A tubular device intended to be used in combination with a compatible flexible endoscope to aid in Endoscopic overtube, endoscopic insertions and to secure a pathway for 36 B reusable multiple endoscopic intubations during diagnostic and therapeutic endoscopic procedures (e.g., upper and/or lower gastrointestinal (GI) tract endoscopy). A sterile, flexible tube intended to be used with an 37 Endoscopic spray catheter endoscope (e.g., colonoscope) to administer fluids B (e.g., dyes for mucosal coloration) in spray form. Page 4 of 17A non-sterile device made with Hevea natural rubber latex (NRL) intended to be connected to an enema 38 Enema tip, reusable A tube to facilitate delivery of an enema solution into the rectum. A non-sterile, length of tubing that is used as a conduit between the enema bag and the enema tip 39 Enema tube A for the delivery of the enema solution into the rectum. A collection of non-sterile compounds and devices intended to be used to prevent and/or remove, Enteral feeding tube 40 through biochemical action, an enteral formula clog B clearing kit in an in situ enteral feeding tube to maintain luminal patency. A non-sterile, sheath-covered device intended to be Enteral used to mechanically clear a clog in an in situ 41 feeding/decompression nasogastric, nasoenteral, gastrostomy and/or A tube clearing stem jejunostomy tube, used for feeding and/or decompression, to maintain luminal patency. A non-sterile, thin, flexible tube intended for extracorporeal connection to an enteral feeding tube Enteral tube extension, (e.g., nasogastric tube) to increase the length of 42 B non-sterile tubing from the patient to an oral/enteral device (e.g., syringe) during enteral feeding/medication administration or aspiration. A sterile, thin, flexible tube intended for extracorporeal connection to an enteral feeding tube Enteral tube extension, (e.g., nasogastric tube) to increase the length of 43 B sterile tubing from the patient to an oral/enteral device (e.g., syringe) during enteral feeding/medication administration or aspiration. A non-sterile endoscope with a highly flexible sleeve Externally-propelled and distal tip intended for the visual examination of 44 B flexible video colonoscope the entire adult colon [lower gastrointestinal (GI) tract]. A sterile, bioabsorbable, animal-derived substance intended to be injected into a fistula tract (e.g., anal Fistula-repair biomatrix 45 or rectal fistula) to close it by adding volume and D implant promoting the ingrowth and neovascularization of host tissue. An endoscope with a flexible inserted portion Flexible fibreoptic intended for the visual examination and treatment of 46 B choledochoscope the choledoc, better known as the common bile duct (CBD). An endoscope with a flexible inserted portion Flexible fibreoptic 47 intended for the visual examination and treatment of B colonoscope the entire colon [lower gastrointestinal (GI) tract]. An endoscope with a flexible inserted portion Flexible fibreoptic 48 intended for the visual examination and treatment of B duodenoscope the duodenum (the first part of the small intestine). Page 5 of 17An endoscope with a flexible inserted portion Flexible fibreoptic intended for the visual examination and treatment of 49 B enteroscope the small intestine (the duodenum, jejunum, and ileum). An endoscope with a flexible inserted portion intended for the visual examination and treatment of Flexible fibreoptic 50 the upper gastrointestinal (GI) tract [oesophagus, B gastroduodenoscope stomach, and duodenum (the first part of the small intestine), including the pancreas and the bile duct]. An endoscope with a flexible inserted portion Flexible fibreoptic 51 intended for the visual examination and treatment of B gastroscope the oesophagus and the stomach. An endoscope with a flexible inserted portion Flexible fibreoptic 52 intended the visual examination and treatment of the B oesophagoscope oesophagus. An endoscope with a flexible inserted portion Flexible fibreoptic 53 intended for the visual examination and treatment in B pancreatoscope the pancreas. An endoscope with a flexible inserted portion Flexible fibreoptic intended for the visual examination and treatment of 54 B sigmoidoscope the sigmoid colon (the distal S-shaped part of the large intestine leading to the rectum). An endoscope with a flexible inserted portion Flexible ultrasound 55 intended for the visual examination and treatment of B colonoscope the entire colon [lower gastrointestinal (GI) tract]. An endoscope with a flexible inserted portion, Flexible ultrasound combined with an ultrasound probe, intended for the 56 B duodenoscope visual examination and treatment of the duodenum (the first part of the small intestine). An endoscope with a flexible inserted portion, combined with an ultrasound probe, intended for the Flexible ultrasound visual examination and treatment of the upper 57 B gastroduodenoscope gastrointestinal (GI) tract [oesophagus, stomach, and duodenum (the first part of the small intestine), including the pancreas and the bile duct]. An endoscope with a flexible inserted portion Flexible video intended for the visual examination and treatment of 58 B choledochoscope the choledoc, better known as the common bile duct (CBD). An endoscope with a flexible inserted portion Flexible video intended for the visual examination and treatment of 59 choledochoscope, single- the biliary tract and related ducts [e.g., common bile B use duct (CBD), cystic duct, pancreatic duct], and for the removal of gallstones. An endoscope with a flexible inserted portion Flexible video 60 intended for the visual examination and treatment of B colonoscope, reusable the entire colon [lower gastrointestinal (GI) tract]. Page 6 of 17A sterile endoscope with a flexible inserted portion Flexible video 61 intended for the visual examination and treatment of B colonoscope, single-use the entire colon [lower gastrointestinal (GI) tract]. An endoscope with a flexible inserted portion Flexible video 62 intended for the visual examination and treatment of B duodenoscope, reusable the duodenum (the first part of the small intestine). An endoscope with a flexible inserted portion Flexible video 63 intended for the visual examination and treatment of B duodenoscope, single-use the duodenum (the first part of the small intestine). An endoscope with a flexible inserted portion intended for the visual examination and treatment of 64 Flexible video enteroscope B the small intestine (the duodenum, jejunum, and ileum). An endoscope with a flexible inserted portion intended for the visual examination and treatment of Flexible video 65 the upper gastrointestinal (GI) tract [oesophagus, B gastroduodenoscope stomach, and duodenum (the first part of the small intestine), including the pancreas and the bile duct]. An endoscope with a flexible inserted portion 66 Flexible video gastroscope intended for the visual examination and treatment of B the oesophagus and the stomach. An endoscope with a flexible inserted portion intended for the visual examination and treatment of the oesophagus. It is inserted into the body through the mouth. Anatomical images are obtained via a Flexible video 67 camera incorporated at the distal end of the B oesophagoscope, reusable oesophagoscope and are shown on a monitor. This device is commonly used to examine abnormalities in the tissue structure and mucous lining of the oesophagus. This is a reusable device. Flexible video An endoscope with a flexible inserted portion 68 oesophagoscope, single- intended for the visual examination and treatment of B use the oesophagus. An endoscope with a flexible inserted portion Flexible video 69 intended for the visual examination and treatment in B pancreatoscope the pancreas. An endoscope with a flexible inserted portion Flexible video intended for the visual examination and treatment of 70 B sigmoidoscope the sigmoid colon (the distal S-shaped part of the large intestine leading to the rectum). A sterile implantable device intended to be wrapped around the proximal portion of the stomach to reduce stomach volume and facilitate weight loss in 71 Gastric sleeve C overweight/obese patients by attempting to restrict the quantity of food consumed through an increased sense of satiety (fullness). Page 7 of 17A sterile flexible tube intended for orogastric, nasogastric, or rectal insertion to sample carbon dioxide (CO2) from the mucosal vasculature of the 72 Gastric tonometry catheter B stomach or sigmoid colon for the measurement of partial pressure (i.e., tonometry) of CO2 (pCO2) during diagnosis of mensenteric ischemia. An implantable device intended to be used to join Gastrointestinal and transect excess tissue of gastrointestinal 73 anastomosis coupler, structures through the coupling of two ring-shaped D bioabsorbable components that are inserted into the ends of the segments to be attached. An implantable device intended to be used to join Gastrointestinal and transect excess tissue of gastrointestinal 74 anastomosis coupler, non- structures through the coupling of two ring-shaped C bioabsorbable components that are inserted into the ends of the segments to be attached. A multicomponent assembly of mains electricity (AC-powered) devices designed for real-time visualization/navigation of a catheter and/or Gastrointestinal endoscope during insertion in the gastrointestinal 75 catheter/endoscope B tract, by detecting its position/movement within an tracking system electromagnetic (EM) field and displaying three- dimensional (3-D) virtual images on a monitoring screen. A device intended to be used in combination with a compatible flexible endoscope for the application of a gastrointestinal endoscopic clip(s) [not included] to Gastrointestinal the mucosal lining of the gastrointestinal (GI) tract 76 B endoscopic clip applier for endoscopic marking, haemostasis, tissue approximation, closure of luminal perforations, and/or for treating mucosal/submucosal defects during an endoscopic procedure. A sterile device intended to be used in combination Gastrointestinal 77 with a generator to remove a gastrointestinal C endoscopic clip cutter endoscopic clip. A portable, mains electricity (AC-powered) device Gastrointestinal intended to be used in conjunction with a cutter for 78 endoscopic clip cutter C the endoscopic removal of a gastrointestinal generator endoscopic clip. A sterile clip intended to be implanted long-term (>30 days) within the gastrointestinal (GI) tract Gastrointestinal during an endoscopic procedure for endoscopic 79 C endoscopic clip, long-term marking, haemostasis, tissue approximation, closure of luminal perforations, and/or for treating mucosal/submucosal defects. Page 8 of 17A sterile clip intended to be placed short-term (<=30 days) within the gastrointestinal (GI) tract during an Gastrointestinal endoscopic procedure for endoscopic marking, 80 B endoscopic clip, short-term haemostasis, tissue approximation, closure of luminal perforations, and/or for treating mucosal/submucosal defects. A non-sterile flexible tube with electronic sensors at the distal end intended to be inserted through the nose or rectum into the gastrointestinal (GI) tract to Gastrointestinal evaluate peristaltic motility anywhere in the GI tract 81 manometric catheter, B (pharynx, oesophagus, stomach, duodenum, small electronic bowel, colon, and anorectal area) by measuring pressure; it may additionally be intended to measure pH and electrical impedance and contain a lumen. A non-sterile, non-electrical flexible tube intended to be inserted through the nose or rectum into the gastrointestinal (GI) tract for measuring pressure to Gastrointestinal assess peristaltic motility in the GI tract (e.g., 82 manometric catheter, non- B oesophagus, stomach) or rectal musculature and electronic anal sphincter functions, typically in the evaluation of GI disorders [e.g., gastro-oesophageal reflux disease (GERD), faecal incontinence]. A non-sterile, noninvasive pouch designed to be wrapped around the protruding end of a Gastrointestinal ostomy 83 gastrointestinal ostomy tube (e.g., gastrostomy or A tube pocket jejunostomy tube) to hold and support it in order to ensure its stabilization on the patient. A sterile, thin, flexible, hollow cylinder percutaneously inserted into the stomach, typically through puncture of the abdominal wall and stomach after distention of the stomach by endoscopic methods, with an extended portion inserted through the pylorus into the jejunum. It is used to feed a patient who has a physical disability that prevents 84 Gastrojejunostomy tube C oral feeding (e.g., a birth defect of the mouth, oesophagus, or stomach, or a neuromuscular condition that affects chewing and swallowing), and to provide drainage/decompression for the stomach when it is necessary to bypass a longstanding obstruction of the stomach outlet into the small intestine. An implantable device introduced into the gastro- Gastro-oesophageal oesophageal sphincter to reduce a sliding hiatal 85 C antireflux prosthesis hernia, preventing the reflux of gastric contents into the oesophagus. Page 9 of 17A non-sterile flexible tube with electronic sensors at its distal end intended to be inserted through the Gastro-oesophageal nose into the oesophagus and stomach to measure 86 pH/impedance catheter, pH and/or electrical impedance, typically for the B non-sterile evaluation of gastro-oesophageal reflux disease (GERD), gastric ulcers, or other gastrointestinal conditions. A sterile flexible tube with an with an electrical conductor at its distal end intended to be inserted Gastro-oesophageal through the nose into the oesophagus and stomach 87 pH/impedance catheter, to measure pH and/or electrical impedance, typically B sterile for the evaluation of gastro-oesophageal reflux disease (GERD), gastric ulcers, or other gastrointestinal conditions. A collection of non-sterile devices designed as the external portion of a gastrostomy aspiration system intended to be used post-surgery by the patient after Gastrostomy aspiration implantation of the stomach tube for the removal of 88 C system gravity set a portion of stomach contents after meals, by aspiration, to achieve portion control and subsequently weight loss in a morbidly obese (bariatric) patient (≥ 18 years). A sterile, thin, flexible, hollow cylinder intended to be percutaneously implanted by endoscopic methods into the stomach of a morbidly obese (bariatric) Gastrostomy aspiration 89 patient (≥ 18 years) for the removal of a portion of C system stomach tube stomach contents after meals by aspiration when used with a dedicated gravity kit that is the external portion of a gastrostomy aspiration system. A sterile, short, tube that is inserted into the stomach 90 Gastrostomy button C percutaneously to permit long-term enteral feeding. A device intended to be inserted into the stomach percutaneously to appose the anterior gastric wall to the anterior abdominal wall, typically to facilitate the 91 Gastrostomy T fastener C insertion of a percutaneous gastrostomy tube or for procedures requiring stabilization/fixation of hollow gastrointestinal (GI) structures. A sterile connecting device shaped in the form of a "Y" intended for connection to the proximal end of a Gastrostomy tube Y-piece 92 gastrostomy tube to enable administration of nutrient B connector liquids and/or medication through the gastrostomy tube. A slender, rod-like surgical instrument made of metal, typically with groove running along the centre of it distal shaft and/or continuing with an elongated 93 Gastro-urological director malleable wire loop, that is used to guide other B devices or instruments into a selected intracorporeal location during a gastroenterological/urological (GU) procedure. Page 10 of 17A slender, rod-like, hand-held manual surgical instrument, typically made of flexible metal with a 94 Gastro-urological probe blunt bulbous tip, designed for exploring B gastroenterological/urological (GU) structures during a GU procedure. A heavy, hand-held, manual surgical instrument with a spoon-like, sharp-edged distal end on a long thin 95 Gastro-urological scoop shaft that is used to access and scrape tissue from B the common hepatic/bile duct system during a gastroenterological/urological (GU) procedure. A collection of devices intended to be used to deliver 96 Gravity enema set an injection of fluid (e.g., saline solution) into the A rectum to facilitate evacuation of the large intestine. A sterile implantable device designed to isolate the lesser curvature segment of the stomach (magenstrasse) to reduce stomach volume and 97 Implantable gastric clamp C facilitate weight loss in overweight/obese patients through a reduction in food consumption based on an increased sense of satiety (fullness). An assembly of battery-powered devices intended to treat chronic disorders of the pelvis and lower Implantable incontinence- urinary or intestinal tract, typically related to urinary 98 control electrical C and/or faecal incontinence, through the application stimulation system of electrical stimuli to the muscles and/or neural tissue of the pelvic floor/bladder. A small, sterile, implantable device designed to Implantable peritoneal secure a peritoneal or lumboperitoneal catheter in 99 C catheter holder situ by suturing it to the abdominal fascia at the point of entry/exit. A non-sterile, noninvasive device intended to be Intestinal ostomy bag anti- applied to the inner surface of an intestinal ostomy 100 A adhesion device bag to prevent opposing inner walls of the bag from sticking together (anti-pancaking). A collection of non-sterile devices intended to be used for attachment/replacement of an intestinal 101 Intestinal ostomy kit ostomy bag (for collecting intestinal output such as A faeces following a colostomy or ileostomy procedure). A sterile rigid or flexible device intended to be implanted within the abdomen to stabilize a portion 102 Intestinal splint C of the intestine, or to stabilize and protect an injured portion of the intestine. A non-sterile plate, typically with a waist belt for attachment, intended to be placed over an enteric Intestinal stoma stoma (surgically-created artificial opening between 103 shield/support belt, the intestines and the body surface through which A reusable bodily waste is drained) to protect it from harmful external influences (e.g., knocks, friction), to reduce the risk of stomal herniation, or to help maintain Page 11 of 17adhesion of the base plate to the skin. A non-sterile plate, typically with a waist belt for attachment, intended to be placed over an enteric stoma (surgically-created artificial opening between Intestinal stoma the intestines and the body surface through which 104 shield/support belt, single- A bodily waste is drained) to protect it from harmful use external influences (e.g., knocks, friction), to reduce the risk of stomal herniation, or to help maintain adhesion of the base plate to the skin. A sterile, hand-held manual surgical instrument intended to be inserted through an orogastric (or nasogastric) tube to mechanically divert the Intraluminal oesophageal 105 oesophagus away from the site of surgery during B retractor electrical treatments of the heart (e.g., cardiac ablation), to facilitate surgical site access and to help prevent injury to the oesophagus. A sterile, flat stretch of silicone elastomer intended for use as a short-term intra-abdominal dressing following abdominal surgery, when a re-exploration Invasive silicone sheet 106 of the wound/abdomen is planned within a thirty day B dressing period. It is used to achieve temporary abdominal closure to avoid the complications of an open abdomen. A sterile, flexible, single-lumen tube with a distal Laparoscopic needle intended to puncture the neck of the 107 cholangiography B gallbladder (Hartmann’s pouch) during laparoscopic catheter/needle cholangiography to allow injection of contrast media. A sterile, rigid surgical instrument designed to be Laparoscopic grasping introduced through a laparoscope primarily for 108 A forceps, Non sterile grasping and manipulating tissues during a laparoscopic surgical procedure. A rigid surgical instrument designed to be introduced Laparoscopic grasping through a laparoscope primarily for grasping and 109 B forceps, sterile manipulating tissues during a laparoscopic surgical procedure. An instrument designed to grasp a pledget swab at the distal end to obtain cytological specimens and/or Laparoscopic swab 110 to perform blunt dissection during gynaecologic B forceps and/or other (e.g., cholecystectomy) laparoscopic procedures. Page 12 of 17A non-sterile device intended to be used to manually administer fluid (e.g., saline solution) into the rectum 111 Manual enema device to facilitate evacuation of the large intestine through B expansion of the lower intestinal tract and physical stimulation of peristalsis. A device intended to be used to manually administer fluid (e.g., saline solution) into the rectum to facilitate Manual enema device, 112 evacuation of the large intestine through expansion B reusable of the lower intestinal tract and physical stimulation of peristalsis. A portable assembly of manually-operated devices designed to be used by or on a patient to irrigate the Manual rectal irrigation rectum with water, typically to provoke the 113 B system defecation reflex for the evacuation of the bowels to treat/prevent constipation and reduce the risk of faecal incontinence. A mains electricity (AC-powered) motorized surgical Motorized laparoscopic instrument designed for grasping, mobilizing, and 114 B forceps suturing tissues/vessels under direct or endoscopic visualization during a surgical procedure. A sterile, thin, flexible, hollow cylinder designed to access the small intestines (duodenum or jejunum) through the nose and nasopharynx for examination 115 Nasoenteral tube B (e.g., of intestinal contents), treatment (e.g., decompression, short-term feeding), or other purposes. A non-sterile, non-surgically invasive device Nasogastric tube holder, intended to be used to secure a nasogastric tube to 116 B intranasal the nose of a patient to prevent displacement or removal of the tube. A small, non-sterile, noninvasive device intended to Nasogastric tube holder, be used to secure a nasogastric tube to prevent 117 A noninvasive, non-sterile displacement or removal of the tube from the patient. A small, sterile, noninvasive device intended to be Nasogastric tube holder, used to secure a nasogastric tube to prevent 118 A noninvasive, sterile displacement or removal of the tube from the patient. A collection of sterile, invasive devices intended to Non-vascular catheter enable percutaneous Seldinger-type introduction of 119 B introduction set a non-vascular catheter (e.g., drainage catheter) into a body cavity or lumen (e.g., biliary tract, ureter). An electronic device used to monitor the temperature of the oesophagus during surgical ablation of the wall of the left atrium. It typically Oesophageal temperature 120 measures the oesophageal temperature at several B monitor adjacent levels, and displays these temperature values simultaneously to help the surgeon avoid the application of heat high enough to form atrial- Page 13 of 17oesophageal fistulas. A sterile, thin, flexible, hollow cylinder designed as a Paediatric-temperature paediatric or neonatal enteral feeding tube with an 121 C nasogastric/orogastric tube integrated temperature sensor that continuously measures oesophageal temperature. A sterile partially-implantable device intended to Partially-implantable 122 provide access to the peritoneal cavity for infusion C abdominal port/catheter (e.g., insulin, chemotherapeutic agents). A collection of sterile devices intended to be used to obtain a tissue specimen from within the biliary duct Percutaneous biliary 123 system for histological analysis by a percutaneous B biopsy procedure kit endoscopic approach, typically under fluoroscopic visualization. A sterile, flexible tubular device intended to deliver Pharyngeal electrical 124 pharyngeal electrical stimulation for the treatment of C stimulation catheter neurogenic dysphagia. A portable assembly of battery-powered devices intended to be used by, or on a patient, for the Powered rectal/colostomy controlled introduction of a non-medicated solution 125 B irrigation system (typically water) into the rectum to treat faecal incontinence or constipation (rectal irrigation), and/or for colostomy site irrigation. A non-sterile substance intended to be applied to the mucosa of the mouth and/or pharynx to facilitate saprophytic microflora colonization within the oral Probiotic oropharyngeal cavity/pharynx, typically following antibiotic therapy, 126 C mucosa dressing bacterial infection, or injury. It includes probiotic bacteria (e.g., Streptococcus salivarius, Streptococcus oralis) and compounds that create a barrier to facilitate growth of the probiotic bacteria. An endoscope with a rigid inserted portion intended 127 Proctoscope, reusable for the visual examination and treatment of the B rectum and anus. A sterile endoscope with a rigid inserted portion 128 Proctoscope, single-use intended for the visual examination and treatment of B the rectum and anus. A hand-held manual surgical instrument intended to 129 Rectal speculum be used to expand or stretch the rectal orifice/canal B after it is inserted and opened. An assembly of disposable and reusable devices designed to obtain a submucosal tissue specimen Rectal suction biopsy 130 from the rectum using suction [rectal suction biopsy B system (RSB)], typically for histopathological analysis [e.g., to help diagnose Hirschsprung's disease (HD)]. Page 14 of 17A collection of non-sterile, noninvasive devices intended to be used in conjunction with a rectal Rectal/colonic lavage 131 and/or colonic irrigation system to support the A support kit introduction of an irrigation solution into the rectum/colon. An endoscope with a rigid inserted portion intended 132 Rectoscope, reusable for the visual examination and treatment of the B rectum and anus. A sterile endoscope with a rigid inserted portion 133 Rectoscope, single-use intended for the visual examination and treatment of B the rectum and anus. A manual device intended to be used as a handle to Rectoscope/proctoscope 134 hold a rectoscope or proctoscope during an A handle examination procedure. A small cap intended to be fitted to the proximal end of the handle of a rectoscope or proctoscope during Rectosocope/proctoscope 135 an examination procedure to provide an airtight seal A handle end-cap so that air can be pumped through the scope to inflate the bowel. An endoscope with a rigid inserted portion intended 136 Rigid oesophagoscope for the visual examination and treatment of the B oesophagus. An endoscope with a rigid inserted portion intended for the visual examination and treatment of the 137 Rigid sigmoidoscope B sigmoid colon (the distal S-shaped part of the large intestine leading to the rectum). A sterile electrosurgical device intended to be connected directly to the arm of a robotic surgical system to deliver electrosurgical current in a bipolar Robotic electrosurgical configuration (i.e., without a return electrode) from a 138 instrument, bipolar, single- C generator directly to tissues for use cutting/coagulation/ablation during robotic endoscopic (e.g., laparoscopic, arthroscopic) surgery. A surgical device intended to be used in conjunction 139 Robotic surgical retractor with a robotic surgical system to enable retraction of B tissues during a robotic endoscopic procedure. A sterile endoscope with a highly-flexible, self- Self-propelled flexible 140 propelled, inserted portion intended for the visual B video colonoscope examination of the entire colon. A slender, sharply-pointed metal tube designed to introduce or remove gas from the peritoneal cavity Spring-loaded as a therapeutic or surgical/radiological procedural 141 pneumoperitoneum method. It is often inserted into the peritoneal cavity B needle, reusable for the purpose of insufflation [e.g., with carbon dioxide (CO2)] to establish pneumoperitoneum prior to abdominal endoscopy. Page 15 of 17A slender, sharply-pointed metal tube designed to introduce or remove gas from the peritoneal cavity Spring-loaded as a therapeutic or surgical/radiological procedural 142 pneumoperitoneum method. It is often inserted into the peritoneal cavity B needle, single-use for the purpose of insufflation [e.g., with carbon dioxide (CO2)] to establish pneumoperitoneum prior to abdominal endoscopy. A non-sterile magnetic device designed to be inserted into the rectum by the user and retained 143 Static magnetic anal plug there for a specified period of time (e.g., 1 to 2 hours B per day for 10 to 20 days) to help reduce anal haemorrhoids with magnetism. A sterile flexible tube that is inserted into a stoma (an artificial opening in the body, especially in the 144 Stoma drainage catheter abdominal wall, made during a surgical procedure) B to drain bodily waste from an internal stoma container; normally directly into the toilet. A sterile, non-bioabsorbable device intended to be implanted into the abdominal wall during a gastro- 145 Stoma support implant urological ostomy procedure to reduce the risk of C parastomal hernia by supporting the abdominal wall surrounding the stoma. An endoscope with a rigid inserted portion intended TEM/TEO rectoscope, for surgical treatment of the lower part of the bowel 146 B optical during transanal endoscopic microsurgery (TEM) or transanal endoscopic operations (TEO). An endoscope with a rigid inserted portion intended TEM/TEO rectoscope, for surgical treatment of the lower part of the bowel 147 B video during transanal endoscopic microsurgery (TEM) or transanal endoscopic operations (TEO). A non-sterile, multi-lumen, multi-purpose tube intended for oral introduction into the gastrointestinal (GI) tract for both: 1) enteral feeding/gastric Thermal-regulation 148 decompression; and 2) thermal regulation of the C orogastric tube whole body via thermal transfer across the oesophagus (to lower and alternatively elevate core body temperature). A sterile non-bioabsorbable tube intended to be endoscopically implanted transmurally between the 149 Transenteric drainage tube C gastrointestinal (GI) tract and a pancreatic pseudocyst or the biliary tract for drainage. An assembly of electronic devices designed for the internal visualization and examination of sections of Video capsule endoscopy 150 the gastrointestinal (GI) tract using a non-digestible B system video capsule after it has been swallowed by a patient. Page 16 of 17An individual software application program or group Video capsule endoscopy of programs, routines or algorithms that add specific 151 system application B computer assisted display, processing and analysis software capabilities to a video capsule endoscopy system. A non-sterile, battery-powered, electronic component device of a video capsule endoscopy Video capsule endoscopy 152 system designed to be swallowed by a patient for B system capsule the internal visualization and examination of the gastrointestinal (GI) tract. Pancreatic duct stents are often placed in 153 Pancreatic stent C patients who have chronic pancreatitis. Page 17 of 17

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