Photoacoustic endomicroscopy combined with ultrasound (PAEM-US) has been a long-standing expectation for gastrointestinal tumor examination. Here, we introduce a prototype disposable PAEM-US catheter and corresponding power interface unit, featuring catheter switchability, self-internal three-dimensional scanning, and system repeatability for gastrointestinal endoscopy. By utilizing high-fluence relays, cascade insertion loss of the optical waveguide is minimized to 0.6 dB with a high performance of power resistance, and a focus-customizable acousto-optic coaxial probe is designed for high-sensitivity optical-resolution photoacoustic imaging. Imaging capability was demonstrated with in vivo anatomical imaging at 30 frames per second. Imaging results showed co-registered microscopic visualization of the microvascular and stratification of the rat colorectum with lateral resolution of 18 μm and axial resolution of 63 μm, holding great potential in the clinical detection of gastrointestinal diseases.