Recurrent acute pancreatitis (RAP) is a key turning point toward irreversible pancreatic damage. Early chronic pancreatitis (ECP) represents a potentially reversible phase, yet its recognition remains limited in European clinical practice. This study aimed to assess the prevalence of MRI-defined ECP, based on the 2019 Japanese Pancreas Society (JPS) imaging criterion, among patients with alcohol-related RAP, and to identify clinical predictors associated with structural progression.

This retrospective single-center study included consecutive adults hospitalized for alcohol-related RAP between January 2023 and December 2024 at Perpignan General Hospital, France. All patients underwent high-resolution magnetic resonance imaging (MRI) including MR cholangiopancreatography (MRCP) 4–8 weeks after discharge. The MRI-ECP positive criterion was defined as the presence of more than three dilated side branches of the main pancreatic duct, in accordance with the 2019 JPS imaging definition. Patients were categorized as MRI-ECP positive or negative. Demographic, clinical, biochemical, and imaging parameters were systematically compared between groups using non-parametric tests and multivariate logistic regression to identify independent predictors of MRI positivity.

Among 26 eligible patients (92% male, mean age 51.5 ± 9.3 years), nine (34.6%) exhibited MRI features consistent with ECP. Patients with MRI-defined ECP experienced significantly more RAP episodes (mean 3.9 vs. 2.2, p = 0.021). No significant differences were observed regarding CT severity scores, inflammatory markers, or comorbidities. In multivariate logistic regression, the number of prior RAP episodes remained the only variable associated with ECP (OR 4.00, 95% CI 0.79–20.3). Age showed a borderline association (p = 0.07).

MRI-based evaluation during the inter-critical phase identified early structural pancreatic changes in over one-third of alcohol-related RAP patients. A threshold of three or more acute episodes emerged as a consistent risk marker for early chronic remodeling. To our knowledge, this is the first European study systematically applying the 2019 JPS imaging criterion to alcohol-related RAP. Routine post-discharge MRI surveillance could enable timely recognition of high-risk patients and open a preventive window against chronic progression.