Objective To evaluate the clinical efficacy and safety of Hybrid knife versus triangular tip during peroral endoscopic myotomy(POEM) for patients with achalasia of cardia. Methods Data of patients with achalasia of cardia who received POEM in Nanfang Hospital, Southern Medical University from June 2012 to July 2014 were collected and divided into the Hybrid knife group (using Hybrid knife) and triangular tip group (using injection needle and triangular tip). Procedure-related parameters, symptom relief, and adverse events were compared between the two groups. Results A total of 57 patients were selected, including 25 patients in the Hybrid knife group and 32 in the triangular tip group. There were no significant differences on baseline characteristics between the two groups (P>0.05). The mean procedure time was shorter in the Hybrid knife group than that in the triangular tip group (55.3±17.7 min VS 69.5±9.4 min, P=0.038). The mean frequency of devices exchange was less in the Hybrid knife group than that in the triangular tip group (4.5±1.5 VS 10.7±1.7, P=0.000). No serious complications occurred during operation and periodical follow-up in both groups. At one-year follow-up, the treatment success rate was 92.0%(23/25) in the Hybrid knife group and 96.9% (31/32) in the triangular tip group (P=0.576). Conclusion Using Hybrid knife in POEM can shorten procedural time and achieve similar treatment success rate compared to triangular tip.