Diarrhetic shellfish poisoning (DSP) is a severe gastrointestinal illness caused by consumption of shellfish contaminated with DSP toxins that are originally produced by toxic dinoflagellates. Based on their structures, DSP toxins were initially classified into three groups, okadaic acid (OA)/dinophysistoxin (DTX) analogues, pectenotoxins (PTXs), and yessotoxins (YTXs). Because PTXs and YTXs have been subsequently shown to have no diarrhetic activities, PTXs and YTXs have recently been eliminated from the definition of DSP toxins. Mouse bioassay (MBA), which is the official testing method of DSP in Japan and many countries, also detects PTXs and YTXs, and thus alternative testing methods detecting only OA/DTX analogues are required in DSP monitoring. Electrospray ionization (ESI) liquid chromatography–mass spectrometry (LC-MS) is a very powerful tool for the detection, identification and quantification of DSP and other lipophilic toxins. In the present review, application of ESI LC-MS techniques to the analysis of each toxin group is described.