We introduce a highly efficient 48-channel ultrasound beamforming system ideal for ultrasound endoscopy applications. The system includes a transmitter and a receiver that allows for low-area, high-resolution imaging acquisition. The transmitter uses a charge redistribution HV (high-voltage) scheme to generate three-level pulses that actuate the transducer, implemented with the standard CMOS process for optimal cost and power savings. Meanwhile, the receiver features a sub-array structure and a delay generator that reduces the area usage. To achieve high-resolution ultrasound imaging acquisition with low computational power, we developed a Shift Coherence Factor (SCF) algorithm that is hardware-friendly. This approach delivers a lateral resolution of over 20% better than that of the conventional delay and sum (DAS) algorithm, with a contrast ratio of over 30 dB. The system was implemented in a 180 nm standard CMOS process with an area of 24.98 mm2, power consumption of 8.23 mW per channel, achieving a delay resolution of 8.33 ns, and a low-area implementation of 0.52 mm2 per channel. The system offers high-quality imaging acquisition with minimal additional area and power consumption, which has great potential for 3D imaging or catheterized ultrasound systems.