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Introduction Colon capsule endoscopy (CCE) is a non-invasive diagnostic modality offering an alternative to optical colonoscopy. It has gained importance as a triage strategy to sustain colorectal cancer (CRC) screening in low-intermediate risk patients during periods of limited endoscopy capacity. We evaluated the real-world impact of a CCE service as a triage tool for low–intermediate risk patients at a UK district general hospital.Methods This single centre retrospective observational study included consecutive patients with a faecal immunochemical test (FIT) less than 100 µg/g who consented to undergo a CCE between June 2021 and May 2025. The primary outcome was the proportion of patients requiring no further colonic investigation following CCE. Secondary outcomes included completion rates, diagnostic findings, subsequent investigations, and requirement for therapeutic endoscopy. Adequate completion was defined as visualisation of the entire colon or capsule excretion within battery life.Results CCE was performed in 345 patients [median age 65 years (IQR: 53-74); 69% female]. The completion rate was 74% (n=254). CCE had failed to enter the colon in 3% (n=11) and colonic assessment was incomplete in 23% (n=80). Reasons included battery exhaustion with the capsule remaining in the colon (63%), inadequate bowel preparation (11%), intolerance to bowel preparation (10%), capsule overshooting with non-visualisation of the right colon (6%), proximal gastrointestinal factors (5%), technical issues (4%), and patient error (1%). These 91 patients underwent alternative investigations: flexible sigmoidoscopy (55%), colonoscopy (20%), CT colonography (13%), or CT abdomen (12%).CCE detected five colorectal cancers and one oesophageal cancer. Benign colonic findings included polyps (54%), diverticulosis (34%), angiodysplasia (17%), and aphthous ulcers (3%). Polypectomies were performed in 72 patients predominantly via colonoscopy (60%), with adenomatous histology in 60%. IBD was detected in 3%. Benign gastro-oesophageal findings included gastritis (4%), gastric polyps (3%), Barrett’s oesophagus (2%) and hiatus hernia (1%). A formal OGD was required in 19 patients (6%), mainly for Barrett’s and gastric polyp assessment.Overall, 181 patients (52%) required no further colonic investigations following CCE.Conclusions CCE is a feasible and pragmatic triage tool for CRC assessment in low-intermediate risk patients, with over 50% avoiding further colonic investigations. These findings highlight its potential to alleviate pressure on overstretched endoscopy services and support wider adoption of CCE to optimise patient pathways.